ANSWEES 



QUESTIONS PKESCEIBED 



BY 



DENTAL STATE BOARDS. 



BY 



EOBERT B. LUDY, M. D., 

LATE ACTING-ASSISTANT SURGEON, U. S. A., LECTURER ON PRACTICE OF MEDICINL IN 

TEMPLE COLLEGE OF PHILADELPHIA, AUTHOR OF "ANSWERS TO QUESTIONS 

PRESCRIBED BY MEDICAL STATE BOARDS," ETC. 



SECOND EDITION, REWRITTEN AND ENLARGED. 



PHILADELPHIA : 

JOHN JOS. McVEY. 

1905. 



LIBRARY of CONGRESS 
Two Copies deceived 

JAN 4 1905 

Cowngnt tntry 

JW< t 3,/9o 6' 

0USS (X XXc, Noj 

/ 4 5~7 7/ 

COPY B. 






Entered according to Act of Congress, in the year 1905, 

By JOHN JOS. McVEY, 

In the Office of the Librarian at Washington, D. C. 



PREFACE, 



The indorsement of the first edition of this book by teachers 
and students, as shown by numerous expressions of approval, 
as well as by its rapid sale, is extremely gratifying to the author 
and seems to warrant its continuance. 

In the present edition the entire text has been completely re- 
written and thoroughly revised, and all new State Board Ques- 
tions which appeared since the publication of the first edition 
have been added. It is hoped that the careful revision to 
which the work has been subjected has eliminated the errors 
which appeared in the first edition. 

Many persons having an adequate knowledge of the subject 
in which they are tested, fail, because of their inability to inter- 
pret properly the intents and purposes of the questions to be 
answered by them. To aid in this, as well as to afford a con- 
venient manual for the general preparation of Dental Students 
in their work, is the sole object of this book. 

Having collected a large number of questions from different 
States, it was found that duplications occurred ranging from 
30% to 80%, varying according to the several subjects. Thus a 
comprehensive knowledge of these questions and answers will 
serve excellently in the preparation for future examinations 
before such Boards. 

In order to secure a critical interpretation of the questions, 
and concise, } r et complete, answers to the same, the author has 
been favored by the assistance of well-known specialists in their 
several lines, whose competence and experience give to the work 
a range and value impossible of attainment in the product of a 
single author. 

It has been deemed advisable to unite all questions from the 

cm) 



iv PREFACE. 

different States under their respective headings, so that undue 
repetitions of similar questions might be avoided. 

Although standard literature has necessarily been consulted, 
yet, in a work of this character, references would only prove 
cumbersome ; hence they have been generally omitted. 

To Drs. Boom, Buckley, Good, Northrop, Rice, Salvas and 
Thomas, the author makes grateful acknowledgment. The 
high value of their carefully prepared answers is fully appre- 
ciated by him, and will be, he is assured, by those into whose 
hands the work is committed. 

ROBERT B. LUDY. 



SPECIAL AUTHOES. 



Henry H. Boom, 31. JD. 

Professor of Chemistry, Physics and Metallurgy in the Philadelphia 
Dental College. 

Albert C. Buckley, A. M., M. D. 

Associate Professor of Histology in the Medico-Chirurgical College of 
Philadelphia. 

Wm. Harmar Good, A. B., M. D. 

Demonstrator in Physiology at the Medico-Chirurgical College of 
Philadelphia. 

Herbert L. Northrop, 31. D. 

Professor of Anatomy and Associate Professor of Surgery in Hahne- 
mann Medical College of Philadelphia. 

Earl C. Bice, J). Z>. S. 

Professor of Dental Pathology and Therapeutics in the Medico- 
Chiurgical College of Philadelphia. 

J. Clarence Salvas, 1), D. S. 

Philadelphia. 

W. Herscy Thomas, 31. D. 

Lecturer on Surgery, Medico-Chirurgical College ; Assistant Surgeon, 
Medico-Chirurgical Hospital. 

(v) 



CONTENTS. 



PAGE 

I. OPERATIVE DENTISTRY 1 

By J. Clarence Salvas, D. D. S. 

H. PROSTHETIC DENTISTRY 41 

By J. Clarence Salvas, D. D. S. 

IIL ORAL SURGERY 95 

By W. Hersey Thomas, M. D. 

IV. PATHOLOGY 171 

By W. Hersey Thomas, M. D. 

V. PATHOLOGY AND THERAPEUTICS 193 

By Earl C. Rice, D. D. S. 

VI. THERAPEUTICS AND MATERIA MEDICA 207 

By Earl C. Rice, D. D. S. 

1 VII. PHYSICS, CHEMISTRY AND METALLURGY {. 249 

By Henry H. Boom, M. D. 

VIII. HISTOLOGY 317 

By Albert C. Buckley, A. M. , M. D. 

IX. PHYSIOLOGY 353 

By William Harmar Good, A. B., M. D. 

X. HYGIENE 389 

By Robert B. Ludy, M. D. 

XI. ANATOMY 413 

By Herbert L. Northrop, M. D. 
(vii) 



OPERATIVE DENTISTRY. 



What is dental caries? 

Dental caries is the disintegration of tooth tissue. 

Give the etiology and the general preventive treatment 
of dental caries. 

Lactic fermentation. Thorough cleansing of the teeth by 
means of tooth-brushes, powder, dental floss and antiseptic 
Avashes. 

How is dental caries classified? 

It is classified as follows: Superficial, deep-seated, simple 
and complicated. 

What is superficial dental caries? Give treatment. 

It is that stage of the disease in which the caries has not 
penetrated the enamel. The treatment consists in its removal 
with disks and fine stones. 

What is deep=seated dental caries? Give treatment. 

It is that stage of the disease which involves the zone of 
dentin in close proximity to the pulp-chamber. 

Removal of all decay, sterilization, coating the cavity with 
a cavity-lining and filling. 

Give the etiology, prognosis and treatment of inflamma- 
tion of the membranes of the mouth preparatory to oper- 
ations on the teeth? 

The local causes of inflammatory conditions o( the mem- 
branes of the mouth are due to the presence oi' salivary cal- 
culus, to carious, loose, dead or diseased tooth or roots. 

The prognosis is favorable. The treatment consists in the 






2 OPERATIVE DENTISTRY. 

mechanical removal of the deposits on the surfaces of the 
teeth, and in the extraction of incurably-diseased teeth. The 
gums should be massaged at each sitting and the parts 
sprayed several times a day with the following well diluted 
antiseptic solution : 

Euformol 5 j 

Glycothymoline § iv 

Acidi curb gttxxx 

Where the inflammatory condition is the expression of 
constitutional disorder, derangement of the alimentary func- 
tions or catarrhal affection, general treatment is indicated. 

Give a genera! rule for the preparation and formation of 
cavities. Name the points that require special care in 
excavating. 

All frail overhanging walls should be removed, the cavity 
thoroughly excavated, sterilized, and made retentive in form. 
The margins should be smoothed. Care must be taken, while 
excavating, not to expose the pulp. 

Give the recognized stages in the preparation of a cavity 
for filling. 

The recognized stages are : Opening the cavity, removing 
the decay, shaping the cavity. 

Give the general principles governing (a) the prepara= 
tion of cavities for gold fillings, (b) the insertion of gold 
fillings. 

(a) Opening the cavity; removal of the decay; shaping 
the cavity to receive and retain the filling and the prepara- 
tion of the margins. 

(b) Accurate adaptation to the cavity walls; solidity and 
proper contour. 

How should the preparation of a cavity for a gold filling 
differ from the preparation of a cavity for an amalgam 
filling? 

A cavity for gold requires direct access; the walls should 



OPERATIVE DENTISTRY. 3 

be strong, and the margins smooth and beveled. Retention 
should be secured by well-defined pits or grooves drilled in 
the dentin. 

A cavity for amalgam should be more or less ball-shaped; 
the cavity should be enlarged from within, the enamel-walls 
parallel, the angles removed and straight sides made concave. 

What form of burs is preferable for removing deep= 
seated decay? Give reason for using this form and state 
method of use. 

The round or oval form of burs. They are preferable be- 
cause their form is similar to that of the natural outline of 
the cavity and, when properly used, they are not so apt to 
injure the subjacent dentin. They are manipulated by means 
of the handpiece of the engine and should revolve rapidly. 
The instrument should be lifted at short intervals and allowed 
to run free, to avoid heat from friction, and consequent pain. 

What instruments should be used to smooth or finish 
cavity margins? 

Chisels, broad-faced excavators, approximal trimmers, and 
file-cut enamel finishing-burs, Arkansas stones, etc. 

What form of bur should be used (a) for opening and 
following the course of sulci; (b) for forming the floor of 
a cavity for a gold filling? 

(a) The fissure-bur; (b) the inverted cone. 

Mention the form and advantage of excavator points for 
removing deep=seated decay in teeth. 

Spoon-shaped or round-bladed. Their cutting edge being 
oval or circular in form, the layers of decayed tissue can be 
removed without injuring the subjacent tissue. 

Describe the method of excavating a cavity extending 
to the pulp, giving the form of excavator and the manner 
of use. 

The orifice of the cavity is enlarged and. with a round- 
bladed excavator, the decay is removed just below the enamel 



4 OPERATIVE DENTISTRY. 

line. The remaining portion of the carious dentin is re- 
moved by placing the blade of the excavator near the base 
of the cavity and with draw-cuts towards the orifice each 
layer of decay is removed. 

Round-bladed excavators of various shapes, according to 
the position of the cavity, are used. 

Give the general treatment and care of teeth in case of 
white decay. 

The carious matter should be carefully removed and the 
cavity sterilized, after which it should be filled with perma- 
nent gutta-percha or some other plastic. Teeth prone to this 
kind of decay should be subjected to frequent examination. 

Describe your method of preparing and filling approxi= 
mal cavities in bicuspids and molars. 

Access to the cavity is secured by separating the teeth. 
If the occlusal surface is weak, it should be removed, thus 
converting the cavity into a compound cavity. All decal- 
cified tooth structure is removed. Frail walls should be 
trimmed away and the cervical aspect of the cavity extended 
so as to secure a solid base. The floor of the cavity is made 
flat, avoiding sharp angles. The occlusal portion of the cavity 
should have a V shape, and the margins should be beveled 
and smoothed. A retaining groove or pit should be placed 
at the cervical termination of the cavity and slight under- 
cuts made in the approximo-occlusal walls. The rubber dam 
and the matrix adjusted, a mat of crystal or fiber gold is 
introduced and with a foot-shaped plugger malleted to place, 
care being taken to carry the gold over the cervical wall. By 
this method the upper third of the cavity is filled. Cohesive 
gold is then added and used to complete the remainder of 
the filling, which should be contoured the natural shape of 
the tooth. The gold should be well burnished and polished 
with strips and sandpaper disks. 

In simple approximal cavities the cavity should be ex- 
tended buccally, so that it can be approached from the buc- 
cal aspect. The decay and the margins should be treated as 



OPERATIVE DENTISTRY. 5 

before described. With an inverted cone-drill the cavity can 
be made retentive in form and crystal or fiber gold inserted. 

How would you prepare and fill an approximal cavity 
with frail walls extending to the cutting edge of an incisor? 

The cavity should be thoroughly excavated and all frail 
margins of enamel should be removed. The labial margin 
of the cavity is brought to the cutting edge in a direct line, 
the cervical aspect of the cavity shaped as a flat ledge, the 
base at right angles with the axis of the tooth. The lingual 
margin should correspond to that of the labial to within a 
few lines of the cutting edge, where it should turn at right 
angles and extend across the tooth at the cutting edge to a 
point a little beyond the depth of the cavity. Anchorage is 
obtained by cutting a groove in the cervical ledge and by 
making an undercut in the dentin near the incisal border. 
The margins should be bevelled and smoothed. Cohesive 
gold in the form of ropes or cylinders is used. The cervical 
groove is filled first and the gold built down towards the 
incisal edge, where it is securely anchored. The mass should 
be kept on a line with the labial and palatal Avails. The 
gold should be carried well over the margins and thoroughly 
condensed with a broad-faced plugger, using sufficient to 
permit of proper shaping and finishing. 

How should cervical cavities be prepared with reference 
to the gum margin? 

The margin should be extended well rootwards in order 
to include any defect in the enamel bordering it. The walls 
should be made smooth and free from angles. 

By what means can cavities be protected from moisture 
without recourse to the rubber dam? 

By the use of cottonoid or small linen napkins in conjunc- 
tion with the saliva-ejector. 

What is hypersensitive dentin? Give treatment. 

It is an irritated state of the tubular contents of the den- 



6 OPERATIVE DENTISTRY. 

tin and prevails principally near the junction of the dentin 
with the enamel. 

The cavity should be thoroughly dried by the use of abso- 
lute alcohol, followed by blasts of warm air ; this may be fol- 
lowed by Robinson's remedy, caustic potassa and carbolic 
acid, equal parts. 

How should a cavity be treated and filled when the 
dentin is highly inflamed?' 1 ' 

Oil of cloves should be sealed into the cavity for a few 
days, the decay then removed, using sharp instruments, and 
the cavity lined with "cavitine, " after which it may be 
filled with cement. 

State the most efficient and satisfactory treatment of 
teeth that have become sensitive with a tendency to decay 
under plate clasps. 

The affected parts should be treated with a 25 per cent, 
solution of nitrate of silver. 

Describe the treatment of anterior teeth that are sensi= 
tive at the gingival border. 

An ant-acid mouth-wash should be prescribed and a solu- 
tion of glycerin and tannic acid applied to the sensitive part. 

Why does the contact of fillings of different metals re= 
suit in shock to the teeth? 

Because of a galvanic action taking place when the two 
metals are brought in contact. 

Why are teeth recently filled more liable to shock from 
thermal changes than other teeth? Give preventive 
treatment. 

It is because of the immediate contact of a filling, espec- 
ially a metallic filling, with the tubular structure of the 

* This question is answered presuming that its author used the expression 
"highly inflamed dentin" as synonymous with hypersensitive dentin. In- 
flammation of the dentin, if there is such a pathological condition, has no 
bearing whatever on cavity preparation. 



OPERATIVE DENTISTRY. 7 

dentin. It may be prevented by interposing a layer of non- 
conductive material. 

Describe the treatment of a tooth that is extremely sen= 
sitive to thermal changes after filling. 

A gutta-percha cap placed over the affected tooth and 
allowed to remain until the pulp recovers from the hyper- 
emia. "When the severity and continuance of the pain is 
such as would give rise to inflammation, the filling should be 
removed and the cavity treated, after which it should be 
lined with a cavity-lining and a soft filling inserted. 

Give the cause and treatment of pits on the labial sur- 
face of teeth near the incisaS edge. 

They are caused by imperfect development of the enamel. 
If the pits are shallow, they may be obliterated by grinding 
the surface with a corundum wheel, converting the surface 
at this point into a distinct concavity. When the pits are 
deeper, they are enlarged and filled. 

What is erosion? Give its cause and treatment. 

It is a chemical disintegration of tooth tissue, occurring 
principally upon the labial surfaces of the teeth. It is 
caused by the action of an acid secretion, the motion of the 
lips assisting in the disintegrative process. 

The treatment consists in prescribing an ant-acid mouth- 
wash. When the disintegration involves the dentin to any 
extent, the cavity is prepared and filled. 

Define abrasion. State causes and give method of 
restoration. 

Abrasion is a mechanical wearing of the crowns of the 
teeth. It is caused by defective occlusion and excessive 
wear. Restoration is effected by the adjustment of crowns 
or porcelain tips, etc. 

Is the deposit of secondary dentin physiologic or patho- 
logic? 

It is physiologic. 



8 OPERATIVE DEXTISTBY. 

What is meant by the term " eburnation?" 

The process by which the dentinal tubuli become obliter- 
ated by calcific deposits. 

How should teeth be separated for the purpose of in= 
serting a filling? 

By means of pellets of cotton, linen tape, strips of caout- 
chouc or by the mechanical separator. 

What pathologic condition may result from wedging 
teeth? 

Disorganization and consequent death of the pulp. 

Why are the risks especially great in rapid wedging of 
the superior central incisors? 

Because there may occur a separation of the superior 
maxilla and the possibility of the incisors not returning to 
their normal position. 

How should teeth that have been wedged be guarded to 
prevent injury during the process of filling? 

They should be held firmly in place by means of orange 
wood, gutta-percha or phosphate of zinc. 

What is the best treatment to render a cavity aseptic? 

The removal of decay and the application of carbolic acid. 

Name the different materials used in filling teeth. 

Oxysulphate of zinc, oxychloride of zinc, oxyphosphate of 
zinc, oxyphosphate of copper, gutta-percha, amalgam, tin. 
gold and porcelain. 

What advantages has gutta=percha as a filling material? 

It is non-conductive, non-irritating, insoluble, and easily 
manipulated. 

In what class of cavities should gutta=percha rather than 
metallic fillings be used? 

In deep cavities upon the buccal surfaces of molars ex- 
tending beneath the sum and not involving the masticating 



OPERATIVE DENTISTRY. 9 

surface ; in approximal cavities of the anterior teeth extend- 
ing beneath the gum, in labial cavities, especially in teeth 
which are loose. 

Describe the insertion and finishing of a gutta=percha 
filling. 

The gutta-percha should be softened by warming it over 
a suitable device, after which it is introduced piece by 
piece, using broad-faced instruments, care being taken to 
adapt the gutta-percha to the margins of the cavity. The 
finishing consists in trimming the portions overlying the 
margins with a warm instrument. The instrument should 
be directed towards the margin and not from it. 

For what class of teeth and for what operations is phos- 
phate of zinc valuable? 

For children's teeth and as a temporary filling in per- 
manent teeth ; in frail teeth with extensive cavities or as a 
lining to be covered with a metallic filling; as a retaining 
medium in crowns, bridge-work and porcelain inlays. 

In what class of cavities is cement unsafe? 

In cervical cavities. 

In what class of operations is the oxychloride of zinc 
indicated? 

In filling root-canals, capping pulps and lining cavities. 

State the advantages of amalgam over the other plastic 
fillings. Give reasons. 

It is more durable and possesses a wider range of appli- 
cation, which is due to its insolubility and its property of 
withstanding the stress of mastication. 

State the conditions under which amalgam should be 
used for fillings. Give reasons. 

Wherever it is not exposed to view or where gold is 
contra-indicated. Its unsatisfactory color excludes it as a 
filling for the anterior teeth. 



10 OPERATIVE DENTISTRY. 

Describe the method of preparing and inserting an amal= 
gam filling. 

The alloy and the mercury in proper proportions are placed 
in a mortar and with a pestle the mass is mixed. When 
amalgamation is completed, it is transferred to the palm of 
the hand and kneaded with the fingers, after which the sur- 
plus mercury is squeezed out. It is introduced into the cav- 
ity in small pieces and pressed against the walls by tapping 
or burnishing. "When the cavity is filled, the edges are 
neatly trimmed with pieces of punk. The filling should be 
polished at a subsequent sitting. 

How should the margins of a cavity wall be prepared for 
an amalgam filling? 

The margin should be so prepared that the amalgam in 
its adaptation is not worked to a feather edge. 

What are the physical changes in an amalgam filling 
after it is placed in a tooth? 

Crystallization, contraction and expansion. 

How should an amalgam filling in a compound cavity, 
involving the approximal and masticating surfaces of a 
molar, be inserted? 

A matrix should be adjusted and the amalgam introduced 
from the masticating surface, care being taken to have it 
well burnished against the matrix and the margins of the 
cavity. 

What advantage has amalgam over gold for filling teeth? 

The plastic nature of the amalgam renders its introduc- 
tion simpler and quicker. In cavities difficult of access it 
can be better adapted to the margins. 

Under what conditions are the plastic fillings preferable 
to gold? 

When the dentin is in a hypersensitive condition; when 
the cavity encroaches upon the pulp-chamber; in frail teeth 
and in deciduous teeth. 



OPERATIVE DENTISTRY. 11 

In what class of cavities is tin preferable for filling? 

In temporary teeth. 

Describe method of inserting a filling of tin. 

The tooth should be isolated with the rubber dam, the 
tin introduced in strips or rolls, using shallow but well- 
defined serrated points. The tin is carried to the floor and 
walls of the cavity, and by the wedging process it is thor- 
oughly adapted. As the filling approaches the marginal sur- 
face, broader points and condensers are employed. The 
surface should be well burnished and the filling finished 
by means of fine stones and disks. 

State why tin fillings arrest decay in teeth when gold 
fillings fail? 

Because the tin possesses antiseptic properties and, owing 
to its softness, is better adapted to the Avails of the cavity. 

What are the characteristics that render gold such a 
desirable filling material. 

Pliabilty, softness, tenacity and agreeableness of color. 

What advantages has gold over the other materials used 
for fillings? 

It possesses better edge strength, it is not affected by the 
oral fluids, and it retains its form when properly inserted. 

How should a cavity be prepared for a gold filling? 

Frail walls should be removed, the cavity thoroughly ex- 
cavated, and the margins carefully bevelled and smoothed. 
Anchorage is obtained by deepening the cavity at its cervical 
termination and by making a shallow groove in the denim 
near the incisal or occlusal border. 

What special precautions should be observed in insert- 
ing gold fillings in approximal cavities? . 

They should conform to the natural shape of the tooth 
and should be as inconspicuous as possible. 



12 OPERATIVE DENTISTRY. 

What is the difference between cohesive and non= 
cohesive gold? State the working method of each. 

Cohesive gold is a preparation of gold which possesses the 
property of cohesion. It is worked on the welding principle. 

Non-cohesive gold does not possess the property of cohesion. 
It is worked on the wedging principle. 

In what respect is non=cohesive gold preferable to 
cohesive gold for filling teeth? 

It is more readily adapted to the walls of the cavity. 
State the advantages of cohesive gold? Give reasons. 

Owing to its cohesive property the pieces may be welded 
one to another, thus a filling of any size or shape can be 
made with it. 

Give the technic of preparing and filling with cohesive 
gold an approximal cavity. 

The teeth are separated until sufficient space is secured, 
the rubber dam adjusted and the frail walls on the approx- 
imal surface broken away with a small chisel, care being 
taken to preserve as much of the labial wall as possible. 
After the decay has been removed, using burs or excavators, 
the margins should be beveled and smoothed by means of 
plug-finishing burs. Anchorage is obtained by grooving the 
dentin at the cervical termination, using small, inverted cone- 
burs, and by making a shallow undercut in the dentin near 
the incisal border. The gold is introduced in small pieces, 
packed into the groove at the cervical border, using shallow, 
serrated plugger-points. When firmly anchored, the gold is 
built along the floor and the palatal wall to the incisal groove. 
The construction of the filling along the palatal wall should 
precede that of the labial aspect of the cavity, thus facili- 
tating contouring. When the filling approaches the labial 
margins of the cavity, a shallow, serrated foot-plugger should 
be used for the remainder of the operation. The pellets of 
gold should be laid in regular order and carried well over 
the margin of the cavity, care being taken not to allow the 
plugger to come in contact with the enamel. 



OPERATIVE DENTISTRY. 13 

Where would you use non=cohesive gold? 

In occlusal, buccal, lingual, labial and simple approximal 
cavities; also as a lining in cavities with frail walls in com- 
bination with cohesive gold. It is especially serviceable in 
minute cavities and in those difficult of access. 

Give the technic of preparing and filling an approximal 
cavity with non=cohesive gold. 

Access to the cavity is secured by separating the teeth. 
The cavity is excavated by means of rose-head burs and 
spoon-shaped excavators. It should be made oval or circular 
in form, the margins bevelled and smoothed, and the floor 
of the cavity made flat and larger than the orifice, employ- 
ing for this purpose the inverted cone-shaped bur. The 
gold is introduced in strips or rolls, using broad, well- 
serrated pluggers and by means of hand-pressure. Consid- 
erable and well directed force is essential. 

Describe a method of securely anchoring a gold filling in 
a distal cavity with frail palatal walls in a vital superior 
cuspid. 

Anchorage is secured by cutting grooves in the dentin at 
the cervical border and by cutting an extension-arm in the 
palatal surface near the incisal edge. 

Describe a method of filling an occlusal cavity in a molar 
with shallow sulci radiating from a deep central cavity. 
Describe the form and condition of gold used in the 
operation. 

The central portion of the cavity should be filled with 
semi-cohesive foil and the radiating sulci with cohesive foil, 
care being taken to have the filling well anchored at the ex- 
tremities of the fissures. 

State the best method of applying gold to the walls of 
cavities in poorly calcified teeth. 

Cavities in teeth of this character should be lined with 
oxyphosphate. While the cement is still soft, pieces of plas- 



U OPERATIVE DEXTISTFY. 

tic gold are pressed into it, and the surplus cement carefully 
removed. When the cement has become hard, the pieces of 
plastic gold are thoroughly condensed and the filling com- 
pleted with cohesive foil. 

Give method of treating and filling a very sensitive su= 
perficial cavity with gold. 

The sensitiveness is relieved by the use of carbolic acid 
and blasts of warm air, after which the cavity is prepared 
aid coated with a solution of Canada balsam and chloro- 
form. It should then be filled with either non-cohesive or 
with plastic gold. 

Mention the class of cavities in which a combination 
of non=cohesive and cohesive gold should be used. Give 
reason for their use. 

A combination of non-cohesive and cohesive gold is indi- 
cated in approximal cavities with frail walls, in meso- 
occlusal and disto-occlusal. in occluso-buccal and occluso- 
lingual cavities. 

The advantage of employing non-cohesive and cohesive 
gold in combination is. that the non-cohesive can be easier 
and better adapted to the floor and margins of the cavity, 
while with the cohesive gold for finishing the filling, contour 
and greater density is obtained. 

Give the technic of filling a cavity with a combination of 
cohesive and non=cohesive gold. 

Where a matrix is indicated, this device is adjusted, the 
tooth having been previously isolated with the rubber dam. 
The cavity prepared, a roll or mat of non-cohesive gold is 
placed in the cavity, extending some distance beyond the 
cervical border. This is followed by one or more rolls, 
which should be malleted to place, using a foot-shaped 
plugger. This is continued till a third of the cavity is filled, 
when very cohesive gold is introduced and the filling com- 
pleted, using slightly serrated plugger-points. The gold 
should be carried well bevond the beveled margin on the 



OPERATIVE DENTISTRY. 15 

occlusal surface and thoroughly condensed with a small, 
finely-serrated foot-plugger. 

What causes the surface of gold fillings to blacken in 
some mouths? 

The action of sulphites, either taken with the food or 
produced chemically in the mouth; the incorporation of for- 
eign substances with the gold during its insertion; imper- 
fectly prepared cavities, where the gold next to the floor 
and walls of the cavity, if poorly condensed, will absorb 
more or less of the carious products. The contamination of 
the gold with mercury, owing to the use of an amalgam- 
burnisher, is also a potent factor in causing discoloration of 
gold fillings. 

When the walls of a cavity have softened beneath an 
approximal gold filling extending beneath the gums, how 
should the cavity be treated and filled? 

The softened tissue is thoroughly removed, extending the 
cavity well rootward, space having been previously secured 
and the gums forced away. The repair can then be made 
either with permanent gutta-percha or with plastic gold. 

Mention the various combination fillings and state the 
advantage of their use. 

Gutta-percha and cement, amalgam and cement, gold and 
cement, gold and amalgam, gold and tin, and the different 
forms of gold in combination. The advantage of combining 
filling materials consists in the elimination of the disadvan- 
tages of each when used separately, and in the utilizing the 
advantages of each when in combination. 

Designate a class of cavities in frail teeth when a com- 
bination filling of gutta=percha and zinc phosphate is in= 
dicated and give technic of operation. 

In those cavities that extend beneath the gum. The rub- 
ber dam and matrix is adjusted, the latter to prevent the 
gutta-percha from being forced out into the soft tissue. 
The cavity is excavated, sterilized and coated with Canada 



16 OPERATIVE DENTISTRY. 

balsam dissolved in chloroform. The cervical margin is 
then filled with gutta-percha and the remainder of the cav- 
ity with cement. When sufficiently hard, it is polished and 
coated with melted paraffin. 

Give the technic of filling with gold and tin. 

The tin is introduced into the cavity in strips or rolls and 
with a short foot-plugger it is condensed against the floor 
and lower walls, carrying it over the cervical wall. Non- 
cohesive gold is then inserted in the same manner until two- 
thirds of the cavity is filled. The remainder of the cavity 
is filled with cohesive gold, which is contoured the natural 
shape of the tooth. Or a sheet of tin foil may be placed be- 
tween two sheets of gold and the whole folded and used as 
would be gold or tin alone. 

Describe a method of restoring with a combination of 
gold and cement badly=decayed, frail crowns of teeth. 

The rubber dam adjusted and the cavity margins bevelled, 
the lower third of the cavity and the walls are lined with 
a quick-setting cement. When the cement is hard, retaining- 
grooves are made and the gold introduced, and the filling 
finished in the usual manner. 

Mention the class of operations in which a combina= 
tion of gold and amalgam is preferable to either material 
used separately. Give reason. 

In cavities involving the disto-occlusal surface of bicus- 
pids and the meso-occlusal surface of molars. Amalgam 
alone is objectionable owing to its color. It is, however, 
valuable in filling the cervical borders of cavities difficult of 
access. Because of its plastic nature, adaptation to the mar- 
gins is better and more easily secured than with gold alone. 

Give technic for inserting a combination filling of 
gold and amalgam. 

The matrix and rubber dam are adjusted and the cavity 
sterilized and dried. A quick-setting amalgam is introduced 



OPERATIVE DENTISTRY. 17 

and burnished well against the floor and lower walls, filling 
in this way a third of the cavity. A rope of non-cohesive 
gold is then inserted, holding it in place with one hand, while 
with the other it is packed on the amalgam and against the 
Avails, using an oval-shaped foot-plugger. Several layers of 
this gold are used ; the filling is finished with cohesive gold. 

Describe in detail the method of restoring with a com- 
bination of amalgam and cement frail, broken crowns. 

The edges of the cavity should be carefully trimmed and 
the rubber dam adjusted. Amalgam sufficient to fill one- third 
of the cavity is prepared. Before inserting it, two-thirds of 
the cavity are filled with soft cement, into Avhich the amal- 
gam is placed, forcing the cement into every portion of the 
cavity. That which oozes out is carefully removed from 
the margins and the filling finished with amalgam. 

State in what class of cavities and under what condi- 
tions a matrix is essential. 

In distal compound cavities of bicuspids and molars. It 
is especially essential when plastics are employed. 

State the advantage and disadvantage of a matrix. 

It converts compound cavities into simple cavities and 
facilitates contouring. When employed in mesial cavities, it 
obstructs the light and makes it difficult to adapt the gold 
to the cavity margins. 

What are the camparative merits of hand and mallet 
pressure? 

Hand pressure permits of greater distribution of force, 
Avhich is essential in the condensation of the non-cohesive 
and the plastic golds. It produces less shock to the tooth 
and is less liable to injure the walls of the cavity AA'hen brought 
in contact with them. 

Mallet pressure permits of Avorking with greater rapidity 
It possesses marked penetrative force and gives greater den- 
sity to filling. 



18 OPERATIVE DENTISTRY. 

Give technic of the operation of restoring teeth by the 
use of porcelain inlays. 

The cavity should be prepared so as to be free from under- 
cuts, the edges should be smooth and square. Where high- 
fusing porcelain is to be employed, the matrix must be made 
of rolled platinum one one-thousandth of an inch in thick- 
ness. It should be well annealed and placed over the cavity 
into which it is forced with a ball-burnisher or with a pellet 
of wet cotton, care being taken to have the margins smooth 
and sharply defined. The matrix is then removed and heated 
to redness in order to destroy all organic matter. The body 
should be thoroughly mixed with distilled water, dried with 
blotting-paper and placed in the matrix with a fine-pointed 
spatula. Tapping the pliers which hold the platinum, will 
settle the body to the bottom. It is then dried by holding 
it a few seconds at the opening of the muffle, into which it is 
gradually introduced and baked until a gloss appears. When 
cool, it is placed in the cavity. The edges are now re- 
burnished and sufficient body is added to fill the matrix com- 
pletely and to give the desired shape to the filling. It is 
dried and baked as before. The platinum should now be 
stripped off and the under surface grooved with fine disks. 
The cavity should be thoroughly dried and undercuts made, 
after which it is partially filled with cement and the inlay 
pressed home. 

How may excessive contraction be avoided in making 
large contour porcelain fillings? 

By imbedding one or two small chips of a porcelain tooth 
in the body mixed for the first baking. 

What class of cavities and what condition of the teeth 
are most favorable for the insertion of porcelain inlays? 

Labial, buccal and simple approximal cavities. Frail and 
sensitive teeth. 

What are the advantages of the porcelain inlay as a 
filling material? 

It resists the action of the oral fluids, is non-conductive 



OPERATIVE DENTISTRY. 19 

and possesses harmony of color and strength to withstand 
mastication. 

Describe a method of making gold inlays. 

An impression of the cavity should be taken in modeling 
compound and run in oxyphosphate of zinc. From this is 
made a matrix of No. 36-gauge pure gold, which is also 
burnished to fit the cavity in the tooth. It is then removed 
(the under surface should be coated with whiting to prevent, 
the solder from flowing over the edge) and 22-carat solder 
flowed into the matrix, using enough to fill it partially. The 
contour or cusp, as the case may be, is obtained by placing 
in the matrix mats of crystal gold, and filling the interstices 
with 22-carat solder. The filling is then inserted in the same 
manner as a porcelain inlay. 

In what class of cavities and in what condition of teeth 
is the gold inlay indicated? 

In frail teeth and in compound approximal cavities of bi- 
cuspids and molars. 

When are artificial crowns and bridges indicated and 
when not? 

A crown is indicated when filling materials fail to prop- 
erly restore a tooth to usefulness. It is counter-indicated 
when the root is diseased. 

When one or more teeth are to be inserted and proper 
anchorage can be secured, a bridge is indicated. AYhen there 
are no desirable abutments and when gum tissue is to be 
restored, a bridge is counter-indicated. 

(a) What is thermal test? (b) how is it conducted, (c) 
for what purposes is it useful? 

(a) Thermal test is the application of water to the teeth 
20 to 60 degrees F. below the blood-heat, and 20 to <S0 de- 
grees F. above the blood- tempera lure. 

(&) The rubber dam is adjusted; cavities, if present, 
should be closed with a pellet of wet cotton. A stream of 
water is injected with a syringe. 



20 OPEBAT1TE DENTISTRY. 

(c) To diagnose the condition of the pulp, also the degree 
of sensitiveness of the dentin. 

What is odontalgia? of what is it the symptom? 

Odontalgia is pain in the tooth; it is the symptom of 
some functional or structural disturbance of the pulp. 

What methods should be employed to distinguish and 
locate odontalgia from idiopathic neuralgia? 

The thermal test, also tapping of the tooth. 
What are the characteristic symptoms of neuralgia aris= 
ing from a crowded denture? 

Keflex pain generally felt in the head and face and ex- 
tending down the neck. 

What is pulpitis? Give etiology and symptom. 

Inflammation of the pulp. It is caused by the invasion 
of bacteria, the close proximity of a filling, by a blow, or the 
continued irritation resulting from thermal changes. The 
symptom is severe pain, increased by the application of heat. 

Give treatment in case of pulpitis. 

In cases where the inflammation is acute in character, a 
pledget of cotton saturated with oil of cloves or creosote 
applied to the pulp and sealed in the cavity for a few days. 
The cavity is then carefully excavated, the pulp protected 
and the filling inserted. 

In cases of chronic pulpitis the inflammation should first 
be allayed by the application of oil of cloves, after which 
the pulp should be devitalized and extirpated. 

How should a congested pulp be treated? 

If the congestion is acute, the pain may be allayed hj an 
application of a sedative, the pulp capped and a temporary 
filling inserted. If the hypergemia is chronic, the congestion 
is relieved, after which the pulp is devitalized and extirpated. 

How should a freshly exposed pulp be treated? 

The pulp and the adjacent tissues are thoroughly steril- 
ized and the pulp capped. 



OPERATIVE DENTISTRY. 21 

Give treatment of inflammation of the pulp in a su= 
perior central incisor that has a gold filling in good 
condition in the approximal surface. 

The pulp chamber is opened from the distal surface 
(the basilar pit), the inflammation subdued by applying 
formalin, 3 per cent., after which the pulp is devitalized 
and extirpated. 

Describe the method of treatment in painful pulp ex- 
posure. 

The inflammation is subdued by applications of eugenol 
and the pulp protected from external influences by dressings 
of cotton saturated with sandarac, after which the pulp is 
devitalized and removed. 

When is protection to the dental pulp from thermal 
changes indicated and how is it accomplished? 

When a cavity is deep-seated or when a tooth is excessively 
sensitive to heat or cold. 

It is protected by means of a cavity-lining. In a tooth 
not affected by caries, the sensitive part — if in an incon- 
spicuous place — is coated with a solution of nitrate of silver ; 
in the anterior teeth with a solution of tannic acid and 
glycerin. 

How may irritation of the dental pulp be determined 
and located when there. is no pulp exposure? 

By means of the thermal test and percussion. 

When the pulp of a tooth has sloughed, having dis= 
charged through a cavity, how should it be treated and 
filled? 

The canal should be sterilized with a 4-per-cent. solution 
of formalin followed by sodium dioxid. It is then thor- 
oughly scraped and washed with hot water, after which it is 
dried, using alcohol and warm air. A dressing of eugenol 
is sealed with temporary gutta-percha and removed once a 
week until all evidence of decomposition has disappeared. 
when the canal and cavity may be filled permanently. 



22 OPERATIVE DENTISTRY. 

How may an inflamed pulp be diagnosed and located 
when no cavity exists? 

By isolating the tooth and the application of heat and 
percussion. 

When should a pulp be capped, and why? 

When it has been exposed, either accidentally or when the 
exposure is of recent origin, the result of caries, and then 
only in such cases where there has been no congestion and 
no evidence of inflammation. The object is to protect the 
pulp from pressure and to assist it in overcoming any bac- 
terial invasion with which it may have been affected. 

What symptoms would counter=indicate the capping of 
a pulp? 

Local pain, reflected pain, soreness to touch and suscep- 
tibility to heat. 

Describe minutely your treatment and manner of cap= 
ping a pulp. 

The rubber dam adjusted, the cavity is thoroughly cleansed, 
sterilized and dried. A dressing, composed of carbolic acid 
and oil of cloves, equal parts, combined with zinc oxid to 
make a paste, is placed over the pulp, care being taken not 
to produce any pressure. This is protected with a concave 
disk of pure tin. A filling, temporary in character, may then 
be inserted. 

What classes of operations tend to induce a patholo- 
gical condition of the pulp and membranes of the teeth? 

The correction of irregularities, excessive grinding of teeth, 
rapid wedging, the preparation of cavities, and the placing 
of fillings in too close proximity to the pulp. 

What are pulp stones? Give treatment. 

Pulp stones are a formation of calcified matter within the 
pulp cavity. The treatment is devitalization and removal of 
the pulp. 



OPERATIVE DENTISTRY. 23 

Give diagnosis of irritation from pulp stones. 

The pain is dull and reflected and the paroxysms are fre- 
quent. There is sensibility to cold and seldom pain on per- 
cussion. When the teeth are sound, the affected one can be 
determined by the thermal test. 

What causes the deposit over an exposed pulp? 

Irritation of the dentinal fibres which increases the func- 
tional activity of the pulp. 

When should a pulp be devitalized? 

When it has become the seat of irritation from pulp nod- 
ules, chronic inflammation or morbidity. In cases of trau- 
matic exposure, as in fractured teeth, and for the purpose 
of inserting certain forms of crowns. 

What are the risks attending the devitalization of pulps 
by arsenic? 

The destructive action on the adjoining tissues in case of 
its escape from the cavity. 

How should a pulp be devitalized by arsenic when de- 
cay exists below the soft tissues? 

The soft tissues are pressed out and protected with tem- 
porary stopping, after which arsenic may be applied. 

Give a safe and reliable way of applying arsenic for the 
devitalization of pulps. 

The rubber dam should be adjusted, the arsenic applied 
and the cavity filled with oxychlorid of zinc. When the 
rubber dam is removed, the surrounding tissues should be 
bathed with a solution of dialized iron. 

What are the symptoms of arsenic poisoning of the gum 
tissue? 

The gum is of a bluish- white color, there is pain about the 



24 OPERATIVE DENTISTRY. 

affected parts, and the teeth are sore and loose in their 
sockets. 

Give a method of removing pulps other than by de= 
vitalization. 

The pulp is carefully exposed, a saturated solution of 
cocaine in chloroform applied, and the cavity filled with a 
piece of unvulcanized caoutchouc on which pressure is 
brought to bear with a large ball burnisher. In this man- 
ner the pulp can be anesthetized in a few minutes, after 
which it is removed in the usual way. 

Describe the diagnostic signs of a dead pulp in a tooth 
when there is no pulp exposure. 

There is no response to the application of excessive cold, 
especially that produced by an ethyl chlorid spray. There 
is also a marked opacity of the tooth. 

How would you diagnose a diseased pulp in an appar= 
ently sound tooth? 

Diseased pulps may be diagnosed by their altered response 
to the thermal test and by tapping. 

How should a pulp canal be prepared for filling? 

It should be well opened and thoroughly cleansed by 
means of instrumentation and sterilization. 

State a method of filling pulp canals. 

Oxychlorid of zinc introduced upon strands of fiber asbes- 
tos; also chloro-percha introduced in the canal in which 
gutta-percha points are inserted. 

Describe a method of filling a root canal having a large 
apical foramen. 

The canal is thoroughly dried, the walls are moistened with 
eucalyptus, a gutta-percha cone, approximating in size the 
foramen, is inserted and forced up until the patient flinches, 
after which the canal is filled in the usual manner. 



OPERATIVE DENTISTRY. 25 

How should crooked buccal root canals be treated and 
filled? 

The canal should be opened by means of sulphuric acid 
and the Donaldson's canal-cleanser, after which they are 
syringed with a solution of chlorid of zinc, which is fol- 
lowed by blasts of warm air. The canal should be filled 
with chloro-percha containing hydronaphtol. 

Give the method of removing a pulp and filling the root 
canals in inferior molars with approximal cavities in 
distal surfaces. 

The cavity must be sufficiently enlarged to permit of 
direct access to the pulp-chamber. The pulp is removed with 
a barbed broach, the canals are well opened, sterilized and 
filled with gutta-percha points. 

Under what condition is immediate root=canal filling 
advisable. 

When the pulp has been extirpated en masse. 

What is mummification of the dental pulp? State un- 
der what condition such treatment would be advisable. 

It is the method by which the pulp is deprived of its 
moisture, or so changed as to be impervious to putrefactive 
agents. 

When the canals cannot be thoroughly cleansed and filled, 
this treatment is indicated. 

Describe a method of treating a perforated root where 
the gum has grown through the opening, filling the pulp 
chamber and resembling a fungoid pulp. 

The growth should be removed by means of a fine-pointed 
lance, the tissue having been previously anesthetized with 
ethyl chlorid. The bleeding can be controlled by means of 
applications of tannin. Pellets of cotton, saturated with 
tincture of iodine, are packed against the tissue, and the 
canal and cavity filled with cotton dipped in sandarac var- 
nish. This treatment is continued each day, or until the 
margins of the perforation are plainly seen. The canal 



26 OPERATIVE DENTISTRY. 

should then be cleansed, sterilized, dried and tilled with 
gutta-percha to about half its depth. A piece of platinum 
foil, No. 60, is then cut, slightly larger than the perfora- 
tion, dipped in chloro-percha and placed against the opening. 
The remainder of the canal is filled with zinc phosphate. 

Give the treatment of inflamed periosteum resulting 
from the filling of pulp canals. 

It consists in the application of counter-irritants to the 
gums. 

Why do pulpless teeth loose their natural hue? 

It is because of the death of the protoplasmic processes 
contained in the dentinal tubules — the result of the removal 
of the main central organ. 

What causes the pink color sometimes found in teeth? 

It is the absorption of the hemoglobin by the tubular 
structure of the dentin, resulting from the breaking-down 
of the corpuscular elements in the blood. 

What causes pulpless teeth to blacken? 

The absorption of the products of decomposition of the 
proteid elements of the pulp by the dentinal tubules; also 
the effect of metallic salts which are used in dental thera- 
peutic treatment. 

Give a method for bleaching teeth. 

Remove all extraneous matter, adjust the rubber dam and 
fill the upper third of the root with gutta-percha, Pyrozone 
(25 per cent, etherial solution of hydrogen dioxid) is ap- 
plied to the remaining unfilled portion of the canal. It 
should be introduced on small pledgets of cotton and inserted 
by means of a platinum canal-plugger. After each applica- 
tion the solution is evaporated by blasts of warm air from 
a hot-air syringe. This is continued until the desired effect 
is produced. 

What diseases may arise from a putrescent pulp? 

Pericementitis and alveolar abscess. 



OPERATIVE DENTISTRY. 27 

What causes pericementitis? 

Pericementitis is the result of inflammation of the pulp, 
irritation from a dead or decomposed pulp, the use of 
arsenious acid, salivary calculus, mercurial poisoning, maloc- 
clusion, excess of filling material, and caries extending be- 
yond the margins of the gum. 

What characteristic pain results from pathological con- 
dition of the peridental membrane? 

Dull continued pain, elongation of the affected tooth, with 
painful response to pressure. 

What are the distinguishing symptoms of pericemental 
and pulp pain? 

Pericemental pain is increased by pressure upon the 
affected tooth. Pulp pain responds to thermal variations. 

Give treatment of pericementitis. 

The pulp-chamber is opened to give vent to the incased 
gases, after which the canal is thoroughly reamed, cleansed 
and sterilized. A dressing of cotton saturated with campho- 
phenique is sealed in the canal and changed from time to 
time until all odor and pain has disappeared, when the tooth 
may be filled. When the tooth is too sore to permit of thor- 
ough instrumentation, counter-irritants are applied and qui- 
nine and ammonol administered in small doses. 

Describe the treatment of pericementitis when the root 
canal is permanently filled. 

The treatment consists in the application of counter- 
irritants to the gum and in the administration of sedatives 
and a saline cathartic. Should this fail to give relief, then 
the gum is deeply scarified, the filling removed from the 
canal and the canal treated antiseptically. 

Give the diagnosis of pericemental abscess. State the 
treatment employed and medicaments used. 

The tooth is loose, elongated and sore, the gum swollen 
and inflamed. There is a feeling of relief when pressure 



28 OPERATIVE DENTISTRY. 

is applied. The treatment consists in applying counter- 
irritants to the gum and in gaining access to the abscess 
tract along the line of the root, in which is injected a 3 
per cent, solution of pyrozone followed by a 10 per cent, 
solution of chlorid of zinc. 

How should alveolar dental abscess be treated? 

The treatment of alveolar abscess consists in gaining free 
access to the diseased area, in opening, cleansing and steril- 
izing the canals. The abscess tract is then washed with a 
3 per cent, solution of pyrozone. If the abscess is without 
a fistula, an effort is made to evacuate the pus through the 
canal. Should this fail, an entrance must be gained through 
the gums, which is accomplished with a pointed bistoury or 
engine-drill. If the abscess has a fistula, it is sometimes 
necessary to enlarge it in order to allow a free escape of 
the pus. The entire tract is then washed with a 3 per cent, 
solution of pyrozone and the canal treated with cotton dress- 
ings of campho-phenique or Black's 1, 2, 3 mixture. This 
is repeated at intervals of two or three days until the abscess 
cavity is healed, when the canals and the cavity can be 
filled. In chronic cases, where the disease fails to respond 
to the medicinal treatment, amputation of the root is in- 
dicated. 

What is a blind abscess? 

It is a chronic abscess without a fistula. 

What is the treatment of an alveolar abscess without 
fistula when the roots have been properly treated and 
filled? 

An opening is made through the gum and the alveolar 
process, and the pus evacuated. The abscess-tract is then 
washed out with a solution of 3 per cent, pyrozone followed 
by an injection of a 10 per cent, solution of chlorid of zinc. 

What is root amputation? Describe the operation. 

It is the excision of the apex of the root. The operation 
consists, first, in rendering the parts aseptic. A vertical in- 



OPERATIVE DENTISTRY. 29 

cision is then made, exposing the process. With a large rose- 
head bur, sufficient of the process is removed to permit of 
working on the root. The opening thus made is packed 
with cotton saturated with phenol sodique until the bleeding 
ceases. The portion of the root to be removed is then ex- 
posed and with a small, rapidly-revolving fissure-bur, ampu- 
tated. The excised portion is taken out by means of a small 
excavator. The edges of the remaining root are smoothed 
with a sharp scaler. The cavity is sjrringed with mercuric 
chlorid, 1-1,000, and packed with iodoform gauze. This 
dressing is renewed after a few days. The patient is in- 
structed to use frequent washes of phenol sodique. 

Describe the process of replanting teeth and state pre- 
cautions necessary. 

The mouth is thoroughly sterilized and the tooth extracted. 
It is immediately placed in a warm solution of mercuric 
chlorid, 1 to 1,000. The socket from which the tooth has 
been removed is syringed with pyrozone and packed with 
cotton saturated with campho-phenique. The tooth is dried, 
and if the root has been denuded of the pericementum, that 
portion is cut away and the end smoothed. The canal is 
opened, sterilized and filled with gutta-percha; the tooth is 
then returned to the antiseptic solution. The cotton is re- 
moved from the socket, which is again washed with pyrozone 
and the tooth then returned to position. It is attached to 
the adjoining teeth with ligatures and held firm for a week 
or ten days. 

Describe the operation of implanting and the precau- 
tions necessary. 

The operation of implanting consists in making an in- 
cision through the gum tissue. By means of the trephine 
or a reamer, a socket is drilled into the maxillary bone. Dur- 
ing the process of preparing the socket, the tooth to be im- 
planted is frequently inserted until the proper adjustment 
has been secured. When this is obtained, the tooth and the 
contiguous parts should be placed in aseptic condition. The 



30 OPERATIVE DENTISTRY. 

tooth is then inserted and held firm by means of ligatures 
until nature has deposited a calcific matrix around it. 

The precautions necessary are thorough asepsis and the 
avoidance of dangerous anesthetics. Care must be taken in 
preparing the sockets for the superior central incisors be- 
cause of the proximity of the anterior palatal nerve and 
vein. With the lateral incisors care must be taken to pre- 
serve the labial plate of the alveolus. The bicuspid and 
molar region present the danger of perforation of the floor 
of the maxillary sinus. 

In the lower jaw the precaution necessary to avoid the 
vessels passing through the mental foramen. 

Give diagnosis of exostosis. State the cause and treat= 
ment. 

There is more or less pain in and about the region of the 
deposit. Not infrequently the pain is reflected to parts quite 
remote from the seat of the trouble. In many cases a pro- 
nounced swelling can be felt on the alveolus over the affected 
tooth. 

The cause of exostosis is irritation of the peridental mem- 
brane. Treatment : In the early stages the application of 
iodine may retard its progress. When the disease is well 
advanced, extraction is indicated. 

Give method of extracting a tooth with the root so en= 
larged by exostosis that its removal through the socket 
must result in fracture of the jaw. 

A portion of the alveolar wall over the affected organ is 
removed. This will permit of the tooth being lifted out in 
the usual manner. 

When is the extraction of teeth indicated? 

When teeth are the seat of an incurable disease, or when 
they are associated with diseases of the maxillary sinus or 
the nasal chamber ; to prevent or correct irregularities, in 
case of excessive looseness of the teeth through loss of the 
surrounding tissues. 



OPERATIVE DENTISTRY. 31 

When teeth are retarded in their eruption, thus causing 
considerable pain. In the preparation of the mouth for an 
artificial denture it is sometimes expedient to remove one 
or two remaining teeth. 

Mention some of the conditions which necessitate 
special precautions in extracting teeth. 

Crowded teeth, where the forceps cannot be properly ad- 
justed ; crowns with frail walls, and impacted teeth. 

Give method of extracting the roots of an inferior third 
molar when the crown is broken off and the gums are 
swollen. 

An incision is made in the gum buccally and lingually 
so as to permit getting a firm hold of the root with the 
forceps. Then by an upward and backward movement the 
root is removed. 

Describe the operation of extracting incisors, cuspids, 
bicuspids and molars. 

All teeth with single and rounded roots are removed by 
a rotary movement. Those with flattened single roots by 
an in-and-out movement. The superior molars are removed 
by an in-and-out movement; the inferior molars by an out- 
and-in movement. 

At what age is it best to extract the first permanent 
molar? Give reason. 

When this molar, cannot be permanently preserved, it 
should be retained up to a period between the tenth and 
twelfth year, or until the second molar is about to erupt. If 
lost before that period, it will cause an irregularity. If later, 
the space it has occupied is never completely closed and the 
adjacent teeth will incline towards the vacanl space, thus an 
impairment of the occlusion results. 

What accidents are liable to happen during the extrac= 
tion of teeth? 

The breaking of the tooth or root, the fracture and re- 



32 OPERATIVE DENTISTRY. 

moval of the alveolar plate, the breaking of the tuberosity, 
the fracture of the lower maxilla and excessive hemorrhage. 

Describe the treatment of excessive hemorrhage follow* 
ing tooth extraction. 

The administration of ergot in small doses; packing a rope 
of cotton saturated with a solution of tannic acid, adrenal or 
hydrogen dioxid (25 per cent.), into the alveolus, and a com- 
press made of modeling compound. 

What anatomic changes are produced by the loss of 
the teeth? 

Resorption of the alveolar walls, which results in altered 
facial expression. 

When is the extraction of deciduous teeth indicated? 

"When they are badly diseased, affecting the general 
health; when the permanent teeth are about to erupt. 

What (if any) possible evils may arise from premature 
extraction of temporary teeth? 

Impaction and irregularity of the permanent teeth. 

In doubtful cases how T would you distinguish a tempor- 
ary from a permanent tooth? 

By its size, which is relatively smaller; by the color, which 
is whiter, and by a marked depression on the neck at the 
union of the enamel and the cementum. 

Under what conditions in deciduous dentition is lancing 
of the gums indicated? Explain. 

Fretfulness, inability to sleep and general derangement, 
and when the gum tissue is inflamed. 

The operation relieves the resistance which the gum offers 
to the erupting teeth and allows them free access. 

Describe a method of treating decay in deciduous teeth. 

The decay should be removed, care being taken not to 
encroach upon the pulp, the cavity sterilized or coated with 
a solution of nitrate of silver and filled with one of the 
plastics. 



OPE BAT IV E DENTISTRY. 33 

Give method of treating and filling approximate cavities 
in permanent teeth of children when these teeth are de- 
ficient in lime salts. 

The decay should be thoroughly removed, the cavity steril- 
ized and filled with gutta-percha. 

How should an abscessed deciduous tooth be treated? 

The pulp-chamber should be opened and the pas evacu- 
ated either through the canals or by means of a bistoury 
passed into the swelling. The canals should then be steril- 
ized with pyrozone followed by an application of oil of 
cloves. Several treatments are necessary to obtain thorough 
asepsis, after which the canals are filled with strands of 
cotton saturated with oil of cassia, the cavity with gutta- 
percha. 

Give etiology and treatment of green stain on children's 
teeth; mention the medicaments used. 

It is a growth of fungi (leptothrix) upon the surface of 
the teeth. It is removed with pulverized pumice and tinc- 
ture of iodine applied on a point of orange wood, after which 
the teeth should be thoroughly polished. 

What injury may result from green stain on children's 
teeth? 

Erosion of the enamel, in consequence of which decay takes 
place. 

What are the best materials for filling deciduous teeth? 

Gutta-percha, oxyphosphate cement and amalgam. 

Give the treatment in case of pulp exposure attended 
with pain in a deciduous tooth. 

The treatment consists in allaying the pain with applica- 
tions of carbolic acid, after which the pulp should be de- 
vitalized and removed. 

Give the treatment of exposed pulp in deciduous teeth of 
a child six years of age. Give reasons. 

The treatment indicated is devitalization and removal of 
3 



34 OPERATIVE DENTISTRY. 

the pulp. This is more satisfactory than conservative treat- 
ment, because of the difficulty of properly capping an ex- 
posed pulp in a deciduous tooth. 

How should the pulps of deciduous teeth be devitalized? 

By means of "devitalizing fiber," which should be sealed 
in the cavity and allowed to remain for twenty-four hours. 
Carbolic acid, iodine and aqua ammonia are also effective. 

How should the pulp canals of deciduous teeth be filled? 

With a paste of iodoform and glycerol. 

Give the treatment of a child ten years old whose cen= 
tral incisors are broken, so that the pulps are exposed. 

Powdered cocaine crystals moistened with distilled water 
are applied to the exposed surface of the pulp ; over this 
is placed a small piece of punk to which pressure is applied 
and continued until the pulp is anesthetized. It is then 
removed, the canals are filled with gutta-percha and the 
external opening with gold. At the fifteenth year the teeth 
may be restored to their normal shape by adjusting porce- 
lain tips. 

How should a first permanent molar with inflamed pulp 
be treated in a child seven years of age? 

When the pulp in a first permanent molar has become in- 
flamed, the inflammation should be allayed by applications 
of eugenol and the pulp capped. If pain has existed period- 
ically for longer than a week's time, the pulp should be 
either devitalized or mummified. 

It is, however, highly questionable that at seven years of 
age the first permanent molar would have an inflamed pulp. 

Mention treatment of defective rough condition of sulci 
In children's teeth before softening occurs. 

The fissures should be treated by applications of a 25 per- 
cent, solution of nitrate of silver. 



OPERATIVE DENTISTRY. 35 

Give directions for the general care of the mouth and 
teeth of children. 

Directions should be given for the proper use of the 
brush, dental floss and a suitable tooth-powder. The teeth 
should be cleansed after each meal and frequent examinations 
advised, at which time the surfaces of the teeth should be 
thoroughly polished. 

What is dental orthopedia? 

It is the correction of dento-facial deformities by means 
of regulating appliances. 

What are the principal causes of irregularities in teeth? 

The causes are hereditary, constitutional, and acquired. 
Mention some of the causes of acquired irregularities. 

The premature loss of deciduous teeth, the too long re- 
tention of deciduous teeth, early loss of permanent teeth, 
thumb-sucking, and delayed eruption of permanent teeth. 

What accidents may happen during the correction of 
dental irregularities? 

Death of the pulp, rupture of the pericementum, injury 
to the enamel, and enlargement of the alveoli. 

Name two typical cases of acquired irregularity. De= 
scribe your treatment. 

1. The permanent cuspids standing outside of the arch. 

2. Excessive protrusion of the superior incisor teeth. 
Treatment for case 1 : If space is needed and expansion 

of the arch is contra-indicated, the first bicuspids must be 
extracted. This is frequently sufficient to allow the cuspids 
to assume their natural position. When an appliance is in- 
dicated, the cuspids and molar teeth are banded and small 
hooks soldered to each on the labial and palatine surface 
To these hooks rubber bands or linen ligatures are attached 
and the teeth drawn in position. 

Treatment for case 2: If space is needed, the first bieus- 



36 OPEBATIVE DENTISTRY. 

pids are extracted and the cuspids drawn back by means 
of jackscrews. The anterior teeth are drawn back by means 
of rubber bands attached to hooks soldered to molar bands. 
Notched bands on the central incisors will keep the rubber 
from sliding towards the gum. When the teeth are moved 
to their position, they should be held by means of a retainer, 
consisting of a labial bow attached to anchor-bands placed 
on the second bicuspids. 

How can the upper arch be expanded? 

By means of the coffin-split plate. 

How would you locate an unerupted tooth? 

By means of the X-Rays a radiograph of the parts can 
be taken; this will show the exact position of the tooth. 

How may an unerupted cuspid tooth be drawn into 
position? 

The crown of the tooth is exposed by making an incision 
through the gum. A small hole is drilled in the tooth in 
which a screw is secured. To this is attached a rubber 
band, fastened to a bar extending from the lateral in- 
cisor to the bicuspid. By this means the tooth can be drawn 
to its proper position. 

State a method of reducing an extruding lateral incisor. 

A band is adjusted to the central incisor and one to the 
cuspid. To these bands bars are soldered, one on the labial 
and one on the palatal surface. A rubber band is stretched 
from the palatal to the lingual bar and over the cutting edge 
of the extruded tooth. By this means it can be forced in 
position. 

State the importance of removing deposits from the 
crowns and necks of teeth. 

Deposits on the crowns and necks of the teeth will cause, 
if allowed to remain, inflammatory disturbance of the gums 
and the contiguous tissues. 



OPERATIVE DENTISTRY. 37 

Describe methods of removing these deposits and give 
the subsequent treatment. 

The deposits are removed by means of scalers of various 
sizes and forms. The instrument should be inserted beneath 
the free margin of the gum and drawn towards the occlusal 
aspect. The surfaces thus scraped and the gingival borders 
of the gums are treated with a solution of hydronaphtol and 
alcohol. The teeth should then be thoroughly polished. 

Differentiate salivary calculus and sanguinary calculus. 

Salivary calculus is deposited from the saliva upon the 
exposed surfaces of the teeth. 

Sanguinary calculus is a deposit upon the roots of the 
teeth. It is precipitated from the liquor sanguinis of the 
blood. 

Differentiate pyorrhea alveolaris and salivary calculus. 
Give the cause, prognosis and treatment of each. 

Pyorrhea alveolaris is a flowing of pus from the alveoli, 
attended with more or less destruction of the alveolar pro- 
cess and the adjacent tissues. The exciting causes are a 
subgingival deposit of calculi. The prognosis is favorable, 
except when the disease has become chronic and is in part 
due to constitutional tendencies. 

The treatment consists in a thorough scaling of the teeth 
and syringing with a 3 per cent, solution of pyrozone. The 
pockets are then saturated with trichloracetic acid, after 
which they are treated with tincture of iodine followed with 
a solution of hydronaphtol and alcohol. The teeth, if loose, 
should be ligatured and mal-occlusion corrected. 

Salivary calculus is a deposit from the saliva upon the 
exposed surfaces of the teeth. The treatment, consists in its 
removal by. means of scalers and in polishing of the sur- 
faces of the teeth. 

Pyorrhea alveolaris is sometimes the local manifestation 
of which nutritional disorders? 

Gout, diabetes, chronic rheumatism, scurvy, and anaemia. 



38 OPERATIVE DENTISTRY. 

In the treatment of pyorrhea alveolaris what attention 
should be given to the patient's diet? 

Albuminous food should be prohibited and the free use 
of alkaline waters advised. 

State the uses of nitrate of silver in operative dentistry. 

It is used as a disinfectant, as an obtundant for hyper- 
sensitive dentin on exposed surfaces, as a treatment for 
caries in deciduous teeth ; also in ulcerated conditions of the 
mucous membrane of the mouth. 

Why does the application of nitrate of silver arrest de= 
cay in teeth? 

It forms, with the dentinal substance, an impenetrable 
albuminate of silver which has high antiseptic property. 

What are the uses of sulphuric acid in operative 
dentistry? 

It is employed to open minute root canals, in the treatment 
of carious bone, in the treatment of pyorrhea alveolaris as a 
solvent for concretions upon the root. 

What instruments should receive special attention as re= 
gards sterilizing? What means should be employed to 
effect thorough sterilization? 

All dental instruments should be sterilized. Those more 
apt to be a source of infection are broaches, driDs and all 
instruments used in pulp canal treatment. 

Broaches and drills should be freed from all adhering 
matter and with the other instruments placed in Schering's 
formalin sterilizer. 

Describe the method of examining the teeth of patients 
and mention the instruments used. 

The instruments used are explorers, mirrors, floss silk and 
wedges. Beginning at the median line, the surfaces of each 
tooth are carefully examined with the mirror and explorer. 
The condition of the sulci and approximal surfaces are care- 
fully noted. The lines of apparent contact are tested with 



OPERATIVE DENTISTRY. 39 

the mirror for evidence of discoloration indicating the pres- 
ence of decay. 

Describe method of cleansing the teeth. 

The mouth should first be cleansed with a 10 per cent, 
solution of hydrogen dioxide. With properly shaped scalers 
all deposits about the teeth should be thoroughly removed. 
The surface of each tooth is then polished with rubber pol- 
ishing-cups and finely-powdered pumice; this is followed 
with a brush and suitable tooth-paste. The teeth and con- 
tiguous parts should be sprayed with an antiseptic solution. 

Mention the benefits derived from the use of electricity 
in dental practice. 

Cataphoresis, drying and sterilizing root canals, trans- 
illumination of the teeth and contiguous parts by the electric 
mouth-lamp. Fusing porcelain and furnishing motor power 
for the dental engine, lathe, etc. 



PROSTHETIC DENTISTRY. 



What constitutes the basis of Prosthetic Dentistry? 

A thorough knowledge of the science and art of dentistry, 
together with a high order of manipulative skill. 

How should the mouth be prepared to receive a full arti= 
ficial denture? 

Diseased teeth and roots should be extracted and the mouth 
placed in a healthy- condition. 

In preparing the lower jaw for artificial teeth, how 
many, if any, natural teeth should be left in mouth? 

All teeth in a healthy condition and not interfering with 
the utility and 'with the appearance of a denture should be 
left in the mouth. 

When an impression is required for an artificial denture 
of any kind, what conditions of the mouth should be 
considered? 

The size and shape of the jaws, the palate, whether deep 
or shallow, hard or soft; the alveolar ridge, whether hard 
or soft, and the relative difference between the hard and 
soft parts of the mouth; if there are remaining teeth, their 
condition, whether they are loose or not, or their position 
such as would require special attention in removing the im- 
pression. 

Mention the various materials used for taking im- 
pressions. 

Plaster ot Paris, modeling composition, gutta-nercha ami 
beeswax. 

r 4i ) 



42 PROSTHETIC DENTISTRY. 

What are the requisites for an impression material? 

Plasticity, the property of hardening within a short time 
while in the month and the absence of expansion and con- 
traction, except in a moderate degree. 

What is plaster of Paris chemically? How is it pre= 
pared for dental purposes? 

Natural Sulphate of Calcium less two-thirds of its water of 
constitution. By roasting and grinding gypsum. 

Describe your method of taking a full upper impression 
in plaster of Paris. 

A tray suited to the case is selected and a piece of soft- 
ened beeswax placed across the posterior palatal portion. 
The patient should sit erect with the head slightly forward, 
the operator standing at the right of the chair. The cup 
filled level with the mixed plaster, into which a few grains 
of salt have been sprinkled, is introduced into the mouth, 
and pressed up, with the rear in advance of the front. 
When the parts are completely embedded, pressure should 
be brought on the lips and cheeks so as to force the 
plaster well up over the outside ridge. The tray should be 
held firm until the plaster will fracture with a clear break. 
The cheeks are now distended with the fingers, the tray is 
depressed in the back and with a slight forward and down- 
ward movement it is removed. Should the impression frac- 
ture, the parts are carefully taken away, adjusted to place 
and held with wax. 

What is the best method of taking a partial difficult im= 
pression? 

An impression tray of proper size and shape is oiled and 
filled with plaster. It is introduced into the mouth and 
forced well up. When the plaster is hardened, the tray is 
detached from the impression and removed from the mouth. 
With a blunt instrument the sides and front of the impression 
are broken away, after which the portion covering the 



PROSTHETIC DENTISTRY. 43 

palatal surface is taken out. The pieces are then placed in 
the tray and joined with wax. 

What are the qualities of a good impression? Give test. 

A good impression must have fulness, smoothness and 
sharpness. It should cover a little more surface than the 
finished base-plate; it should reproduce exactly the finest 
lines and be as smooth as the mucous membrane. 

The best test of a good impression is the degree of re- 
sistance offered to its removal. 

How may nausea be prevented in a particularly sensi= 
tive mouth while an impression is being secured? 

By gargling the throat with camphor Avater just before 
taking the impression, or by painting the parts with a one 
per cent, solution of cocaine. 

State the two essential requirements for the production 
of a perfectly fitting denture. 

An accurate impression and model. 

How soon after a plaster impression is taken, should 
the plaster be poured for the model? Give reasons for 
3'our answer. 

The model should be run within a few hours from the 
time the impression has been taken, or before the latter be- 
comes too dry. Thus expansion or porosity, as well as 
crystallization of the salt on the surface of the cast is pre- 
vented. 

How may plaster teeth on models be strengthened to 
prevent fracture? 

By forcing pins into the teeth cavities of the impression 
before the model is poured. 

How should a plaster model be treated when a portion 
of the ridge is soft and the center of the mouth hard? 

The cast should be scraped at, the portion corresponding 
to the soft portion of the ridge and the center should be 



44 PROSTHETIC DENTISTRY. 

relieved by a strip of lead or tin a thirty-second of an inch 
in thickness. 

What properties are requisite for a good base plate? 

It should possess the property of malleability or of being 
rendered soft when subjected to heat, while at the same 
time it should be unaffected by the temperature of the 
mouth. 

Describe the method of obtaining a correct bite for a 
^ full upper and lower set. 

To the upper and lower base plates, which have been 
accurately fitted to the models, a rim of softened beeswax is 
attached, sufficient to secure the fulness and length of the 
teeth to be inserted. The rims are neatly trimmed and the 
trial-plates placed into the mouth. After the proper length, 
contour and correct apposition of the rims have been ob- 
tained, the patient is directed to swallow and bite. This is 
repeated several times to assure accuracy. The median line 
is then marked, the rims are united with a hot spatula and 
the two articulating models removed together. 

What relation should the artificial teeth bear to the 
alveolar ridge? 

The long axis of the teeth should be in line with the 
vertical axis of the alveolar ridge. 

What general principles should be observed in arrang= 
ing artificial teeth for an edentulous mouth? 

The teeth should be arranged so as to restore the expres- 
sion of the mouth and face. 

They should occlude properly and be placed as near the 
center of the ridge as possible. 

What relation in regard to length should (a) the upper 
teeth bear to the upper lip, (b) the lower teeth bear to 
the lower lip? 

(a) The superior teeth should extend below the upper 
lip sufficient to show the tips when the mouth is opened with- 
out raising the lips. 



PROSTHETIC DENTISTRY. 45 

(ft) The lower teeth should be a few lines shorter than 
the lower lip, or so that they are not visible when the mouth 
is in a passive state. 

In Prosthetic Dentistry what is meant by " re=posing 
the features." 

By the term "re-posing the features" we include every- 
thing necessary to bring each and all of the visible parts 
of the face and mouth into harmony of relation to each 
other. (Warren: "Dental Prosthesis.") 

In full dentures are the upper or the lower teeth first 
arranged on the model? Give the general arrangement. 

The anterior inferior teeth are generally arranged first. 
All the teeth except the inferior incisors and the superior 
second molars should have two antagonists in articulating. 

The anterior superior teeth, beginning with the central in- 
cisors, should incline slightly towards the median line, which 
should divide the space between the centrals. The lower 
teeth should stand nearly straight, the cusps of the bicuspids 
and molars occluding inside the cusps of the superior bicus- 
pids and molars. The occlusion should be even on both sides. 

The relative length of the teeth is governed by the articu- 
lating models. 

In articulating a full denture, what teeth should bear the 
greatest pressure of the bite? 

The bicuspids and first molars. 

State the value of the study of temperaments in the 
practice of Prosthetic Dentistry. 

It enables the dentist to select teeth the size, shape and 
color of which conforms to nature's type in the physical 
organization. 

Describe the size, form and color for (a) a bilious, (b) a 
sanguinous, (c) a nervous, (d) a lymphatic temperament. 

(a) Large, rather long in proportion to breadth, angu- 
lar; color, deep yellow. 



46 PROSTHETIC DENTISTRY. 

(b) Well proportioned, length slightly predominating over 
width; color, cream-yellow. 

(c) Length greater than breadth; fine, long cutting edges; 
color, pearl-blue or gray, inclined to translucency. 

(d) Large, breadth greater than length, poorly shaped; 
color, opaque and pallid. 

Explain how an entire upper denture is retained in 
position. 

By atmospheric pressure or adaptation. 

What is the value of relief spaces as compared with 
vacuum chambers in full upper dentures? 

By relief spaces maximum adaptation is secured and pos- 
sible irritation to the tissues avoided. 

What is the Cleaveland vacuum=cavity? 

It is a soldered vacuum-cavity, the cap being a little larger 
than the opening cut in the plate. 

What relation should the vacuum=chamber bear to the 
center of gravity? * 

It should be placed at the center of gravity. 

How would you find the center of gravity of the palatal 
vault on a model of an edentulous upper jaw? * 

The center of gravity can be found by drawing lines from 
the centers of both condyles to the junction of the first and 
second bicuspids on each side. At the point on the median 
line where the lines intersect will be the center of gravity. 

What nerves may suffer from the sharp anterior edge 
of an improperly placed vacuum=chamber? 

The naso-palatine nerves. 

*" Centre of gravity" as applied to an upper denture seems a meaningless 
expression. The vacuum-cavity should be situated at about the centre of the 
area covered by the plate. 



PROSTHETIC DENTISTRY. 47 

What muscles have a tendency to displace (a) an upper 
denture (b) a lower denture? 

(a) Buccinator. 

(&) Mylo-hyoid and geniohyoglossus. 

How may the pressure of an upper artificial denture be 
equalized when portions of the mouth are very hard and 
portions very soft? 

By relieving the impression at such places as correspond 
to the hard portions of the mouth, and by scraping the cast 
at such points as correspond to the soft portions of the 
mouth. 

How may a plate be prevented from rocking in a mouth 
with a hard palatal ridge? 

By relieving the entire central portion of the plate. 

Mention the three principal ingredients used in manu= 
facturing teeth and state which one gives the translucency 
and lifelike appearance to the teeth. 

Kaolin, feldspar and silex. The feldspar is used to pro- 
duce the enamel and to give it translucency. 

What metal is used as a coloring agent to produce the 
grayish=blue tint of the enamel of artificial teeth? 

Platinum. 

What is Purple of Cassius and for what is it used in 
porcelain? 

It is a mixed oxide of gold and tin, and is used to pro- 
duce the gum color in porcelain. 

What color is produced by titanium in porcelain enamel? 

Yellow. 

Describe the difference between !ong=bite teeth and 
short=bite teeth. Mention cases where each would be 
appropriate. 

In long-bite teeth the distance between the cutting edge 
and the pin-guard (the ridge or shoulder of porcelain ex- 



48 PROSTHETIC DENTISTRY. 

tending across the lingual surface of the tooth, which in- 
dicates the extent of the lap of the upper incisors over the 
lower) is greater than that in the short-bite teeth, where the 
ridge is closer to the cutting edge. 

Short-bite teeth are indicated where there is a long ridge 
and a short lip ; long-bite teeth, where the alveolar ridge is 
short and the lip long. Short-bite teeth are also indicated 
where there is but little overlap of the antagonizing teeth, 
and long-bite teeth where the overlap is more marked. 

What are the relative merits of plain teeth and gum 
sections? State where each should be used. 

Plain teeth can be more artistically arranged than gum 
sections. They should be employed only where the teeth are 
to rest directly upon the natural gum, or where the length 
of the lip is sufficient to conceal the artificial rubber gum. 

"Where the lip is short and the gum is more or less exposed 
while laughing or talking, or where there has been consider- 
able resorption of the ridge and greater fulness is required, 
better results are obtained with gum sections. 

Where can pinless or diatoric teeth be advantageously 
used? 

In cases which do not require grinding of the por- 
celain. In cases where they are not required to set 
close to the alveolar ridge. If ground, the undercuts are 
weakened, and if set close to the ridge, their shape does not 
allow of sufficient vulcanite to make a strong denture. 

How soon after extraction of the teeth should full tem- 
porary dentures be inserted? permanent dentures? 

Temporary dentures may be inserted immediately or soon 
after the extraction of the teeth; permanent dentures after 
complete resorption has taken place, which usually requires 
from six to twelve months. 

What are the advantages of countersunk=pin teeth? 

Their close conformity in contour to the natural organs 
makes them more acceptable to the tongue, renders articu- 



PROSTHETIC DENTISTRY. 49 

lation easier and more distinct, and, when properly mounted, 
they present a naturalness of appearance seldom obtained 
with the other varieties. 

Why is a temporary denture desirable? 

To preserve the natural expression of the lips as well as 
the normal position of the lower maxilla. 

Does absorption of the alveolar process advance more 
rapidly with or without a plate? 

With a plate. 

What causes dark joints in gum teeth? how can this 
be prevented? 

The entrance of rubber or of foreign substances between 
the joints. 

It can be prevented by grinding the joints so that their 
surfaces come in perfect contact, thus avoiding a V-shaped 
space and by the use of a very hard-setting plaster for 
flasking. Soft cement placed over the joints will also pre- 
vent the entrance of foreign substances. 

State what causes gum sections to break in the flask? 

The presence of too much rubber and excessive force in 
screwing down the flask. 

Name the various materials used as a base for artificial 
dentures. 

Rubber, aluminum, silver, gold, platinum, celluloid, con- 
tinuous gum and porcelain. 

What base for an artificial denture do you consider 
hygienically the best and why? 

Porcelain or continuous gum. It is hygienically the best 
because of the absence of porosity and of spaces for the 
accumulation of food. 

Where and how is crude rubber obtained? 

Crude rubber or caoutchouc is a milky exudate obtained 
by tapping the Siphonia elastica, a South American tree. 
4 



50 PROSTHETIC DENTISTRY. 

What is the substance known as vulcanite? 

Caoutchouc and sulphur submitted to the process of vul- 
canization. 

Name the principal solvents of rubber. 

Ether, choloroform, kerosene, and the essential oils. 

What is the coloring pigment in red vulcanite, black 
vulcanite, pink vulcanite? 

The coloring pigment in red vulcanite is vermilion: in 
l)lack vulcanite, ivory-black; in pink vulcanite, white oxide 
of zinc and vermilion. 

How may vulcanite be bleached? 

By placing it in absolute alcohol and subjecting it to the 
rays of the sun. 

State the amount of caoutchouc and of sulphur used in 
making vulcanizable rubber suitable for dental plates. 

Caoutchouc, 48 parts ; sulphur, 24 parts. 

What causes the tissues to inflame under a rubber plate? 

The generation of heat due to the rubber being a negative 
electric and the irritating action of the coloring matter in 
the red rubber — mercuric sulphide (vermilion). 

State the reasons for using black, red and pink rubber. 

When red rubber irritates the tissues, black rubber should 
t>e used. Pink rubber is employed in the anterior part of 
the mouth, because it approximates the color of the gums. 

What is weighted rubber, and where is its use indicated? 

Rubber in which tin filings are incorporated. It is em- 
ployed in lower dentures, to be used in mouths where there 
is little or no ridge and where weight is essential to the re- 
tention of the plate. 

At what degree of heat and how long should a rubber 
denture be vulcanized in order that the best results may 
be obtained? 

It should be vulcanized for fifty-five minutes at a temper- 
ature of 320 degrees F. 



PROSTHETIC DENTISTRY. 51 

What part of an upper denture has the greatest in= 
fluence on the expression of the face? 

The anterior part. 

What are plumpers? where placed? state their use. 

Plumpers are rolls of vulcanite placed on the labial and 
buccal rim of the denture. They serve to restore the features 
of the face. 

What is the guide for the amount of rubber to be 
used in packing a case? 

The wax from the model plate is placed in Starr's meas- 
uring-glass which is half filled with water, noting the height 
to which the water rises. The wax is then removed and 
sufficient rubber is put into the glass to raise the water to 
the same level or a little higher. 

Describe the method of constructing an artificial den= 
ture on a vulcanite base. 

An impression of the mouth is taken in plaster-of-Paris, 
from which is secured a plaster model. If an air-chamber 
is required, it is cut from sheet tin and secured in position 
on the model. A base plate of modeling compound is 
made to conform to the model. To this is attached 
the wax guide or rim, which is trimmed to the desired width, 
fulness and contour. This is placed in the mouth and the 
bite secured, after which it is returned to the model and, 
with the antagonizing model, is placed in the articulator. The 
teeth are arranged and waxed on this temporary plate, which 
is carved and trimmed just as the finished plate is desired to 
be. The model, with the plate, is removed from the articulator, 
the plaster trimmed, moistened and invested in the lower 
half of the flask, the plaster extending to the external rim 
of the wax. The plaster is then smoothed and varnishe ' 
and the upper section of the flask placed in position an 
filled with plaster. When the plaster is hard, the flask is 
heated sufficiently to soften the wax. and the parts are separ- 
ated. The wax is then carefully and completely removed 



52 PROSTHETIC DENTISTRY. 

by pouring a stream of boiling water into the flask and over 
the teeth. 

After the flask has dried for a few minutes, the vents are 
cut and the two halves of the flask placed on the stove and 
heated to about the boiling-point, of water. The case is now 
ready for packing. The rubber is cut in strips and thor- 
oughly warmed: small pieces of the pink, packed between 
the teeth and strips, wide enough to extend from above the 
pins to the edge of the plate, are placed in position. The 
pins are completely covered with the red rubber, which is 
also placed over the palatal portion. No. 3 tin-foil is burn- 
ished to the model and coated with a solution of soap, which 
facilitates the removal of the foil from the vulcanite. The 
flask is closed and heated sufficiently to soften the rubber; 
the parts are then screwed together. The case is vulcanized, 
and when thoroughly cool, the plate is removed, filed, 
scraped, sandpapered and polished. 

With a protruding lower jaw, how far toward the tongue 
may the lower teeth be placed? What relation must they 
bear to the alveolar ridge? 

The lower teeth should not be placed towards the tongue 
farther than the centre of the edentulous ridge. 

They should be arranged as close to the centre of the 
alveolar ridge as possible. 

When would you arrange the teeth of an upper plate to 
occlude directly on the cutting edges of the lower teeth? 

In a case of a person of advanced age. where the lower 
teeth are so abraded that the masticating surfaces are per- 
fectly flat. The cusps of the upper artificial teeth should be 
ground off and the surfaces roughened. 

When a vulcanite upper plate cracks, why does the 
crack usually occur near the median line? 

It is due to the improper arrangement of the molars, in 
consequence of which the strain of mastication is thrown on 
the outside instead of on the top of the ridge. Imperfect 



PROSTHETIC DENTISTRY. 53 

vulcanization, also insufficient rubber behind the incisor 
teeth, are factors in the cause of plates cracking at or near the 
median line. It may be due to resorption of the ridge sub- 
jecting the plate to undue strain. 

How should faulty articulation of artificial teeth be 
corrected? 

When the articulation is slightly faulty the interfering 
points can be detected by placing a strip of carbon paper 
in the mouth and instructing the patient to bite; the points 
thus marked should be removed with a corundum-stone. If 
the articulation is seriously faulty, the denture should be 
remade. 

State how the setting of plaster may be hastened? 

By the addition of a few grains of common salt to the 
mixture. 

Mention some of the causes of failure of artificial den- 
tures. 

Imperfect impression or cast, inaccurate articulation and 
warping of the plate. 

Give a method of correcting a warped vulcanite rubber 
plate. 

A cast of the mouth is secured and thoroughly dried. The 
portion of the plate that needs correcting is heated over a 
spirit-lamp sufficient to render the vulcanite flexible. It is 
then placed on the model, held firm, and with a heavy burn- 
ishing instrument the plate is adapted to the cast. 

State the effect of a hard center and a soft ridge on the 
fit of an upper denture. 

Unless the hard centre is properly relieved, the plate will 
rock. 

A common result of wearing lower plates that accurately 
fit a model, is a tendency of the plates to bury their buccal 



54 PROSTHETIC DENTISTRY. 

edges in the soft tissues; state how this tendency may be 
overcome. 

By cutting away the buccal edge until the plate, when in 
the mouth, will not bear on the soft tissues. 

Mention some of the various methods of retaining arti= 
ficial dentures. 

Atmospheric pressure and clasps and springs. 

Give the normal occlusion of the teeth. 

All of the superior teeth overlap the lower; the six supe- 
rior anterior teeth extend over and cover part of the labial 
surface of the six inferior teeth. In the buccal region the 
buccal cusps of the superior bicuspids and molars cover the 
buccal cusps of the inferior bicuspids and molars. Each 
tooth, except the inferior central incisors and the last supe- 
rior molar strikes against two opposing teeth. 

What is your method of repairing a rubber plate frac= 
tured through the center? 

The two parts of the plate are adjusted together and held 
by means of hard wax dropped on the lingual surface. The 
palatal portion is then oiled and filled with plaster. "When 
the plaster has hardened, the plate is removed from the model 
and the line of fracture enlarged with a file. With a jewel- 
er's saw, dovetails are cut opposite each other, after which 
the parts are placed on the model and the prepared spaces 
filled with wax. The case is invested in the usual way, 
packed and vulcanized. 

Give the method of polishing a vulcanite plate on the 
palatal surface. 

Little or no polishing should be done to the palatal sur- 
face of a plate. A smooth, bright surface can be obtained 
by burnishing No. 3 tin-foil to the model and coating this 
with a solution of soap, just before the flask is closed prior 
to vulcanizing. 



PROSTHETIC DENTISTRY. 55 

How may a gold clasp be attached to a rubber plate? 

By soldering a perforated gold tongue to the clasp in such 
a way that it will be well embedded in the rubber when the 
plate is finished. 

What would result if an upper denture extended too far 
posteriorly and touched the soft palate? 

The muscles of the soft palate would displace the plate 
during the act of swallowing. It is also apt to cause 
retching. 

Describe a method of producing a very thin and rough 
vulcanite plate, both surfaces of which will be nearly 
finished when removed from the flask. 

The case is prepared for flasking in the usual manner; it 
should be smooth and as thin as the finished plate is intended 
to be. No. 60 tin-foil is burnished to the wax ; it should be ap- 
plied in two pieces, one for the lingual surface and one for the 
buccal and labial surface. The edges of the tin-foil are bent 
out sufficiently to escape the investment in the lower section 
of the flask and, at the same time, so as to be grasped by 
the plaster when the upper section of the flask is poured. 
The case is then flasked. When the plaster is hard, the flask 
is placed in warm water to soften the wax; it is opened, the 
wax removed and boiling water poured into the flask and 
over the pins. No. 3 tin-foil is burnished to the cast and 
soaped. The waste-gates are cut and the flask dried, heated, 
packed and vulcanized in the usual manner. 

Can rubber be vulcanized in direct contact with silver? 
Give explanation. 

Rubber cannot be vulcanized in direct contact with silver 
owing to the affinity of the sulphur in the rubber for the 
silver. 

State a method of treating silver so that rubber can be 
vukarized in contact with it. 

The silver may be gilded or coated with tin. 



56 PROSTHETIC DENTISTRY. 

Describe the method of using " Victoria " or other metal 
to strengthen or reinforce vulcanite partial dentures. 

When ''Victoria" metal is used, it is cut to the desired 
size and made to conform to the shape of the mould, placing 
it so that the roughened surface will be embedded in the 
rubber, which is packed directly over the metal. When a 
bar is used, it is embedded in the rubber during the process 
of packing, so as not to show in the finished plate. 

What will be the effect on a rubber plate if it is vul= 
canized for twenty=four hours at 320 degrees F.? 

The rubber will become dark and very brittle. 

Describe the process of constructing an artificial den= 
ture on a celluloid base. 

The plaster impression secured, a metal cast is obtained 
by running the impression in block tin. If a vacuum- 
chamber is required, it should be cut in the impression be- 
fore the model is poured. Taking the bite, articulating the 
case and arranging the teeth is the same as for rubber work. 

The base-plate is made of paraffin and wax compound. 
With a curved knife-blade the wax on the lingual surface 
and on the labial and buccal surfaces is carved so as to 
reproduce the natural characteristics of the gums. The wax 
is made smooth by passing it over the flame of a small burner. 
No. 60 tin-foil is then burnished over the surface of the 
wax. The case is ready for flasking; it is invested in the 
shallow half of the flask designed for this work. The plaster 
must extend just to the borders of the plate. When hard, 
it is trimmed and coated with liquid soap. The deep por- 
tion of the flask is adjusted and filled. When the plaster is 
hard and after sufficient heat has been applied to soften the 
wax, the two sections of the flask are separated. The wax is 
thoroughly removed by pouring a stream of hot water over 
the mould. A groove to permit of the escape of surplus 
material is cut in the plaster encircling the matrix, but not 
connected with the mould. A celluloid blank of the desired 
size is selected and made to conform to the shape of the 



PROSTHETIC DENTISTRY. 57 

mould by heating it in boiling water and pressing it with the 
fingers into the section containing the teeth. The flask is 
then closed and placed in water so as to saturate the plaster. 
The case is ready for moulding, using the hot, moist-air 
machine. The flask is placed in the clamp and the top 
screwed down until it presses the flask, after which it is put 
in the tank and the heat applied. When the temperature 
raises to 225 degrees F., slight pressure should be applied, 
and as the heat increases and the celluloid becomes more 
plastic the pressure is increased. This is continued until the 
flask is completely closed. The heat is then turned off and 
the piece allowed to cool gradually. When perfectly cold, 
the sections of the flask are separated and the plaster and 
tin-foil removed from the case, which is now trimmed and 
polished, employing the same instruments as used in rubber 
work. 

Give the composition of Celluloid. 

Pyroxylin, camphor, oxid of zinc and vermilion. 

Describe the method of constructing a lower artificial 
denture made by the cheoplastic process. 

From a plaster impression a cast of equal parts plaster 
and marble dust is secured. The steps concerned in this 
method are the same as for rubber work up to the flashing. 
In a flask designed for this work the case is invested, using 
equal parts of plaster and marble dust as investment mate- 
rial. After the investment is hard, the sections of the flask 
are separated and grooves cut from the posterior margin of 
the mould to the openings of the flask. All traces of wax 
are removed by boiling water. The mould is then thoroughly 
dried by placing the two halves of the flask over a low heat 
for an hour or more, after which the parts of the flask are 
placed together and clamped tight. The fusible alloy is then 
melted and poured into the mould through one of the open- 
ings of the flask. When cold, the case is removed, smoothed 
with files and sandpaper, and polished with pumice-stone. 



\S 



58 PROSTHETIC DENTISTRY. 

Give the essential properties of metals used for dies. 

Hardness, low fusibility, a minimum of contractility, and 
ability to withstand the force used in swaging. 

Define die, counter=die. Mention the best metals for 
each. 

A die is a metal duplicate of a model. A counter-die is a 
cast, the counterpart of a die. 

Zinc and Babitt metal are used for dies; lead for coun- 
ter-dies. 

Of what is Babitt metal composed? 

Of copper one part, antimony two parts, tin eight parts. 

Give the fusing=points of tin, zinc, and lead. 

Tin about 460° F., lead about 617° P., zinc about 773° P. 

Describe a Hawes rnolding=fiask and state why it is used. 

It is composed of two sections or rings. The lower con- 
sists of three movable pieces with extensions projecting to- 
wards the centre, and which are held together when in use 
by means of pins passing through openings in the joints. The 
upper section is a plain ring which fits on the lower. 

It is used for securing moulds or casts with deep undercuts. 

Describe the method for making and using cores to ob= 
tain accurate moulds from models with deep undercuts. 

The surface of the undercut on the cast is oiled. A mix- 
ture of marble dust and plaster is run into the undercut and 
the wall of the model is extended so as to slant to the base 
of the cast, When this is hard it is detached from the model 
and thoroughly dried over a stove, after which it is placed 
in position on the model and the mould made, the outlines of 
the core being plainly marked. The core is then removed 
from the model and placed in its position in the mould and 
the metal poured. 

Describe a method of obtaining a correct die from a 
lower mode! thit has several anterior teeth standing, the 



PROSTHETIC DENTISTRY. 59 

jaw very much undercut lingually below the neck of the 
teeth. 

The undercut on the model is overcome by means of two 
cores joining at the median line. A mould is then made, 
the cores are removed from the model and placed in position 
in the mould, which should be thoroughly dried and the 
metal poured. 

State the uses of aluminum in dentistry. Describe the 
method of annealing. 

Aluminum is used as a base for artificial dentures and for 
shell crowns. It is annealed by coating the metal with oil 
and holding it over a Bunsen burner until the oil is burned 
off, leaving a white surface. 

State two methods of using aluminum in the construc= 
tion of artificial dentures. 

The method of swaging and of casting. 

Describe the method of making an upper denture on 
swaged aluminum, the teeth to be attached with rubber. 

The die and counter-die secured, aluminum plate of twenty 
guage is annealed and swaged the same as gold. The sur- 
face to which the rubber is to be attached is roughened and 
perforated. The bite and articulation secured, the teeth are 
arranged in the usual manner. The case is invested in the 
lower section of the flask, the plaster extending to the wax 
rim and imbedding the exposed metal surface (the palatal 
portion of the plate) . When the upper section of the flask 
is run and the plaster is hard, the flask is placed in warm 
water to soften the wax. It is opened, the wax removed, 
and boiling water poured over the teeth and over the plate. 
The roughened surface of the plate should be washed with 
absolute alcohol to remove all traces of the wax. The case 
is packed and vulcanized in the usual way. The rubber 
attachment is finished as usual: the metal is polished with 
fine pumice and rouge. 



60 PROSTHETIC DENTISTRY. 

What is the fusing=point of aluminum? 

1160° F. 

Give a formula of aluminum solder suitable for dental 
purposes. 

Tin 55 parts. 

Zinc 23 " 

Silver 5 " 

Aluminum 2 " 

Give two methods of swaging a metal plate. 

A plate cut to the proper size is annealed and placed 
on the die; with a horn mallet the posterior part of the 
plate is driven into position; by this means the central part 
of the plate is brought in contact with the die at its deepest 
portion. The plate is cleansed, re-annealed and placed on 
the die; with a partial counter-die the palatal portion of the 
plate is now swaged, using a heavy swaging-hammer. The 
plate is again annealed, placed on the die and swaged with 
a counter-die extending over the alveolar ridge. The third 
swaging is done with a counter-die that extends beyond the 
plate line. Any wrinkles which have formed are removed 
by means of the horn mallet. 

The Parker 's swaging device : The plate is first roughly 
swaged by means of a die and counter-die and adjusted to 
the plaster model. In this position it is placed in a cast- 
iron cylinder and covered with fine bird-shot; this should 
nearly fill the cylinder. Over this is placed the plunger, 
and with a few blows from a heavy hammer the plate is 
brought into accurate apposition with the plaster model. 

What gauge of gold plate is used for an upper denture? 
what for a lower? State carat. 

26 gauge for an upper denture and two thicknesses of 30 
gauge each for a lower. 
18 or 20-carat. 

What is the result of over=annealing of gold or silver 
plate? 

The surface of the metal fuses, thus destroying its texture 
and rendering it more or less brittle. 



PROSTHETIC DENTISTRY. 61 

What causes gold and silver plates to warp while sold- 
ering? How can it be prevented? 

The warping is due to the contraction of the solder and 
the want of support when heated, or from excess of invest- 
ing material. It can be prevented by having the plate well 
imbedded in the investment, avoiding the use of more mate- 
rial than is needed to make a wall a half-inch thick around 
the teeth. 

What method should be used to correct a slightly warped 
plate with teeth in order to fit a plaster model? 

The plaster model should be dried so as to make it per- 
fectly hard. The plate is placed upon the model and the 
defective portion carefully noted. With a few carefully- 
directed blows from the bench-hammer the plate can be 
brought in contact with the cast. 

Describe the method of forming a rim of a full upper 
gold plate. 

A plaster impression of the gum surfaces of the teeth and 
the exposed border of the plate is taken in two sections, 
each extending from the median line to the heel. From this 
are secured models. Dies and counter-dies are obtained, and 
strips of plate of sufficient width are swaged, fitted to the 
plate and trimmed, after which the rims are held together 
with small clamps and soldered. 

State the precaution that should be taken to prevent 
gold plate from cracking during swaging. 

Frequent annealing. 

Describe the method of constructing an artificial den- 
ture on a gold base using single gum teeth. 

The plaster cast is scraped along the posterior margin of 
the plate line so as to increase the bearing of the plate at 
this point. The die and counter-dies are secured, the plate 
is well annealed and swaged. The vacuum-chamber is cut 
out and one, swaged up separately, is soldered in. The bite 
and articulation are secured and the models adjusted in the 



62 PROSTHETIC DENTISTRY. 

articulator. The teeth are ground to fit the plate accurately, 
allowing a minute space between the blocks for expansion. 
The plate with the teeth waxed in place is invested in an 
investment of* plaster and sand, equal parts. When the 
plaster is hard, the wax is removed and the backings are 
adjusted to the teeth, eare being taken to have them in 
direct contact with the plate. The platinum pins are split 
and spread apart to hold the backings securely in place. 
The case is then boraxed and heated preparatory to solder- 
ing. W Tien it is heated to redness, it is removed, placed on 
a soldering-block and soldered. When eool. the plaster is 
removed and the plate placed in a bath of sulphuric acid, 
after which it is smoothed and polished. 

How is gold solder confined to the desired surface? 

The parts to be kept free from solder are coated with a 
paste of whiting. 

Why is flux used? 

To free the surface of oxides. 

What is the proper method of directing the flow of the 
solder? 

The application of borax and the management of the blow- 
pipe. 

Describe the construction of a gold plate with rubber 
attachment. 

The plate is made and the teeth arranged precisely as they 
would be for a denture where the teeth are backed and 
soldered, except that teeth suitable for vulcanite work are 
selected. Either before the teeth are arranged, or after they 
have been waxed to the plate and adjusted in the mouth, 
a triangular gold wire about Xo. 18 gauge is soldered around 
the alveolar border of the plate to a little beyond the last 
molar of each side, where it should cross the ridge and be 
extended along the inner or lingual line or border of the 
rubber attachment. The object of this wire is to strengthen 
the plate, and also to hold secure the edges of the attachment 



PROSTHETIC DENTISTRY. 63 

and prevent them curling up, as otherwise they are apt to 
do after the denture has been worn for some time. To 
secure the rubber attachment to the plate, gold or platinum 
pins or wire loops are soldered on the ridge, inside the line 
of triangular wire; they should be so arranged as not to in- 
terfere with the teeth nor to show through the rubber after 
the denture is finished. If this is done after the teeth have 
been arranged, plaster guides should be made before the 
position of the teeth has been disturbed, so that they can 
be accurately returned to place after these additions to the 
plate have been made. The plate is now smoothed, the teeth 
arranged, and wax built out and contoured precisely as the 
rubber attachment is desired to be. The case is flasked so 
that the gold plate will be in the bottom portion of the 
flask and the teeth in the upper. It is now packed, vul- 
canized, and finished as would be a vulcanite denture. 

Is a gold lining in a vulcanite plate beneficial? Explain. 

It is, in so far as the gold prevents any irritation of the 
tissues from the rubber. 

How may an old plate be lined with gold? 

The surface of the plate to be covered with the gold is 
thoroughly cleansed with soap and water, after which the 
entire surface is roughened with a sharp-pointed instrument. 
A solution of rubber and naphtha is painted over the rough- 
ened surface and allowed to dry to the point of stickiness. 
Strips of No. 60 gold foil, one side of which have been 
roughened by the electro-deposition of gold, are cut of suffi- 
cient size to form the rim. Where there are depression*, the 
lining should be pressed with a suitably-shaped piece of 
rubber eraser to the lowest point in the plate. Each strip 
should slightly overlap the other, care being taken to avoid 
wrinkling. The plate is then flasked in the usual way and 
vulcanized for twenty-five minutes at from 320° to 330° P. 
It will require no finishing except where the edges of the 
lining overlap. 



64 PROSTHETIC DENTISTRY. 

What are English tube teeth? Describe a method of 
attaching them to a gold plate. 

They are a class of plain teeth made with a platinum tube 
baked in the porcelain, extending through the centre of 
the tooth and corresponding to its long axis. 

The English tube teeth are attached to a gold plate by 
first grinding them to fit the position they are desired to 
occupy. They are held in place by means of hard wax. A 
marking-wire, tipped with vermilion paint, is passed down 
each tooth till it touches the plate. This marks the place at 
which the holes are to be drilled to receive the pins. The 
teeth are removed and the holes drilled. Gold pin-wire of 
the desired length is cut and the end to be inserted into the 
drilled hole is tapered so as to fit tight and project through 
on the palatal surface. The tapered end of the pin and 
the pin-hole are then boraxed and the pin soldered to the 
plate. The teeth are then placed on their respective pins 
and the final adjustment made. Previous to attaching the 
teeth to the pins, shallow grooves are made in the latter with 
a fine file. The teeth are thoroughly cleansed, dried and re- 
placed on the pins. In a small porcelain receptacle sulphur 
is melted, and with a wire spatula the sulphur is conveyed 
to the plate, which is kept heated by holding it with the 
pliers over a burner. The sulphur runs under the teeth and 
along the pins. When cool, it sets hard and the teeth are 
immovable. (American Textbook of Prosthetic Dentistry.) 

Describe a method of constructing a partial lower den= 
ture of gold, the teeth of which are soldered to the plate, 
the six anterior natural teeth being in the mouth. 

The die and counter-die are made, and a pattern of the 
desired plate is obtained in tin-foil. From this is cut two 
plates of gold, 18-carat fine and 30 gauge in thickness. The 
plates are annealed and swaged separately, the under plate 
being a little larger than the upper and both extending one- 
half on the lingual surface of the anterior teeth. The plates 
are trimmed, re-annealed and swaged together. After boil- 



PROSTHETIC DENTISTRY. 65 

ing in the acid solution, the surfaces to be soldered are pol- 
ished and boraxed. They are then placed in apposition, 
heated to redness, after which they are placed between the 
die and counter-die and with a few blows from the swaging- 
mallet are brought in absolute contact. The plates are then 
soldered with 18-carat solder. The plate is now polished, 
placed in the mouth, the bite taken, and with the antagon- 
izing model mounted in the articulator. The teeth are ground 
to fit the plate accurately and the backings adjusted to each. 
With hard wax the teeth are now attached to the plate and 
the case invested in a mixture of plaster and asbestos fiber. 
When thoroughly dried, it is heated to redness and soldered. 
The case is allowed to cool gradually until perfectly cold, 
when it is removed from the investment, boiled in the acid 
solution and finished with files and fine stones, using pumice 
and rouge for polishing. 

Give method of strengthening an upper or lower gold 
plate behind the anterior teeth. 

A duplicate plate, extending from the position of the 
bicuspid of one side to the bicuspid of the other is swaged 
and soldered to the plate proper. The re-inforcement for 
the lower plate should be the same width as the plate ; for 
an upper plate it should extend an eighth of an inch from 
the festooned margins to a point within the same distance 
of the edge of the vacuum-chamber. 

What is the method of repairing a cracked plate of 
gold? 

The parts to be soldered are cleansed. The crack in the 
palatal surface of the plate is covered with a layer of gold- 
foil and the case invested. A piece of plate is then placed 
over the crack and made to conform to the shape of the 
portion of the plate to be repaired. The investment is then 
dried and the case heated and boraxed, after which solder 
is flowed between the two plates. 
5 



66 PROSTHETIC DENTISTRY. 

Can you solder i8=carat plate with i8=carat solder? 
Explain. 

Yes. The alloy of the solder being a low-fusing metal, 
the solder fuses at a lower temperature, although the plate 
and solder are of the same fineness. 

Describe the process of sweating together two pieces 
of gold plate of the same degree of fineness. 

The pieces are placed in apposition and, by careful manip- 
ulation of a broad, full flame of the blowpipe, the plates are 
united by partial fusing of the surfaces in contact. 

Give the fusing=point of gold, silver, copper. 

Gold, 2016° F.; silver, 1873° F. ; copper, 2000° F. 
Give the formula for 20=carat gold plate. 

Pure gold, 20 dwts. ; copper, 2 dwts. ; silver, 2 dwts. 

Which is finer, 20=carat plate or 20=carat solder? Which 
fuses at the lower degree of heat? Why? 

They are of the same fineness. The solder being alloyed 
with a low-fusing metal, fuses at a lower temperature than 
the plate, although they are of the same fineness. (Dr. ¥m. 
H. Trueman.) 

Give a formula for a 22=carat solder. 

Gold ■ 22 parts. 

Copper 1 part. 

Silver f of 1 part. 

Zinc I of 1 part. 

What is the difference between platinous gold and 
platinized gold? 

Platinous gold is the alloy of gold and platinum. Platin- 
ized gold is gold covered with platinum. 

What would be the effect of placing a piece of lead on 
a gold plate during the process of annealing? 

It would impair the ductility of the gold or destroy the 
plate at the spot where the lead fuses on the gold. 



PROSTHETIC DENTISTRY. G7 

What effect has zinc on gold solder? 

It makes it flow easy. Impure, or commercial zinc also 
makes solder brittle. If the zinc is chemically pure it does 
not have this effect. 

Express in carats the fineness of American gold coin. 

21.6 carat. 

Give formula for clasp gold. 

Pure gold 20 dwts. 

Fine copper 2 " 

Fine silver 1 dvvt. 

Platinum 1 " 

Give a method of making a gold clasp. State thickness 
of the metal used. 

From an accurate model of the tooth a pattern is made 
of heavy pattern-tin. This is reproduced in clasp-metal, 24 
gauge. The edges are filed to conform with those of the 
pattern, and the metal, well annealed, is shaped with round- 
nose pliers. 

Give method of attaching a clasp to a gold plate. 

The clasp is adjusted to the tooth in the mouth. The 
plate is placed in its position, and with a plaster impression 
the plate and clasp are removed. The model is obtained and 
the clasp attached to the plate with hard wax. They are 
then removed from the model and embedded in a mixture 
of plaster and sand. The case is then dried and soldered. 

Should a gold clasp be used about a tooth containing a 
large amalgam filling? 

There are objections. In some mouths the contact of the 
two metals may cause more or less galvanic action; this is. 
however, usually but temporary. 

What kind of a denture should be constructed in the 
case of a patient whose superior canines and second molars 
are in position? 

A horse-shoe plate of gold or vulcanite ret ai nod in posi- 
tion by clasping the second molars. 



68 PBOSTHETIC DENTISTRY. 

How are porcelain teeth attached to a metallic base? 

By means of vulcanite or by backing the teeth and solder- 
ing them to the metallic base. 

Why is platinum used for pins in teeth? 

Because it expands less under heat than any other metal 
and possesses the property of fusing at a high temperature. 

What is the fusing=point of platinum? 

3500 - F. 

How would you solder platinum? 

By means of pure gold or an alloy of gold and platinum. 
What are the advantages of continuous gum? 

Cleanliness, natural appearance, durability. It is non- 
irritating and easy of repair. 

Describe the method of constructing a continuous gum 
denture. 

A platinum plate, 29 gauge for the upper or 26 for the 
lower denture, is swaged the same as in gold work. The 
outer edge is re-inforced with No. 19 gauge, half-round plat- 
inum wire, bent to fit the plate along the alveolar edge to 
about an eighth of an inch from the posterior edge of the 
plate ; this is soldered with pure gold. 

To the posterior edge of the plate a strip of platinum 
one-eighth of an inch wide is swaged and soldered, turning 
up the inner edge before soldering. The bite is taken in the 
usual way. The teeth (continuous gum teeth) are arranged 
and secured with hard wax. The}^ are then coated with an 
alcoholic solution of shellac and the case is embedded in an 
investment of plaster and asbestos. When the investment is 
sufficiently hard, the wax is removed and the plate and the 
pins are thoroughly cleansed for soldering. Strips of plat- 
inum of the same gauge as the plate are then fitted to the 
palatal surface of the teeth, extending from the pins to the 
plate. The pins are then bent down over the strip, holding 
it firmly in place. 



PROSTHETIC DENTISTRY. 69 

The case is now boraxed, slowly heated, and when brought 
to a red heat it is removed and soldered with pure gold. 
When cool, the plate is taken out of the investment, cleansed 
and adjusted to the mouth. If satisfactory, the body is then 
applied. 

The body is mixed with a solution of gum-arabic and water, 
and with a small spatula it is packed around the necks of 
the teeth and spread over the surface of the plate. The gum 
is stippled to give a natural appearance. The moisture is 
absorbed with a linen cloth, and with a fine blade clean cuts 
are made between the teeth extending through the body and 
over the surface of the plate, in order to prevent distortion 
of the plate by the shrinkage of the body. 

The plate is now placed upon the investment material and 
thoroughly dried, after which it is conveyed to the mouth 
of the heated muffle, into which it is gradually introduced. 
The muffle is brought up to a white heat, and when the body 
preserts shiny crystals the heat is turned off and the case 
allowed to cool gradually. When thoroughly cold, it is 
placed on the die and the incisions and cracks in the body 
packed solid with new body. The gum enamel is then ap- 
plied. Tapping the plate gently will bring the moisture to 
the surface, which can be absorbed with a napkin. The case 
is dried and baked, using a higher temperature than for the 
first baking. The case is cooled as before and the metallic 
surface polished. 

What is meant by " stippling?" 

Dotting the tin-foil which is burnished over the wax gum 
with a dull-pointed instrument. By this means a more nat- 
ural appearance is produced on the gums of the finished 
denture. 

State the method of replacing a tooth broken from a 
denture of continuous gum. 

The remains of the broken tooth and the contiguous por- 
celain are ground away and a new tooth fitted in place. New 
body is then packed around the tooth, the case dried and 



70 PROSTHETIC DENTISTRY. 

biscuited. When sufficiently cool, the gum enamel is applied 
and the case baked until it becomes smooth and glossy. 

About what degree of heat is required to fuse porce= 
lain in continuous gum work? 

About 2200° F. 

In continuous gum or other work in which porcelain is 
used what is the cause of the porosity sometimes found on 
breaking the piece? 

Insufficient baking, or over-heating. 

Describe the construction of an upper denture of porce= 
lain. 

Two casts are taken from a plaster impression of the mouth 
and a thin lead plate is burnished to one of the casts. Soft- 
ened beeswax is then placed on the ridge and the articula- 
tion obtained in the usual way. The cast and the articu- 
lating model must then be enlarged to allow for the con- 
traction of the porcelain in burning. To accomplish this, 
the cast and articulation are divided into four sections with 
a thin saw. The first division is made at the centre, along 
the mesial line, to the back of the cast; the second division 
back of where the cuspid teeth are located. Before cutting 
the cast, the bottom should be made smooth and level. After 
the case has been divided, the sections are placed together, 
leaving a space of a quarter of an inch between each. This 
is filled with freshly-mixed plaster, the sections being held 
in position by wax. When the plaster is hard, a new lead 
plate is cut and burnished to the cast. The sections of the 
wax articulating model are placed on the enlarged cast and 
the interspaces filled with melted wax; thus the model con- 
forms to the size of the enlarged cast. 

An outside wall is now made for moulding the body. This 
is done by bending a piece of tin around the front and sides 
of the cast (with the wax articulating model on it) to get 
the correct, curve. The tin is then removed one-fourth of 
an inch from the cast in front and at the sides, and is sus- 



PROSTHETIC DENTISTRY. 71 

tained in this position until freshly-mixed plaster is poured 
into the space between the cast and tin. This wall is then 
trimmed; after the removal of the wax the wall should be 
lined with tin-foil. 

The parts are then thoroughly cleansed for moulding. The 
lead plate and inside of the wall should be oiled and a piece 
of body laid on the lead plate before the wall is put in 
place. This is worked over the edge of the gum to the limit 
of the plate line. The wall is then put in place and the 
body packed up against it. The rest of the body is pressed 
down against the surface of the lead plate, extending back 
as far as the plate is to be carried. The body is then dried 
sufficiently to be carved into shape. This is clone roughly 
on the cast, and when reduced to the proper thickness it is 
dried and biscuit-baked When the case is cool, the enamel 
is applied and the final carving and gumming completed. It 
is then dried, placed in the muffle and burned until fully 
glazed. When cool, it is ground to fit the original cast, 
which was left unenlarged. ("American System of Den- 
tistry.") 

What combination of metals makes a good clasp for a 
continuous gum partial case? 

Platinum and iridium. 

Give the formula of platinum solder. 

Gold 95 parts. 

Platinum , 5 " 

Mention the carat and gauge of plate most desirable for 
crowns. 

22-carat and 30-gauge. 

What effect on the shade of teeth has (a) platinum, (b) 
gold backing? 

(a) Platinum gives a bluish, (b) gold a yellowish tint. 

State the precautions that should be taken in backing 
a porcelain facing to prevent checking during soldering. 

The pins should not bo bent close to the tooth. 



72 PROSTHETIC DENTISTRY. 

The pin-holes in the backing should be so placed that the 
metal can be adjusted without using force. 

The backing should be in perfect contact with the por- 
celain so as to protect it from borax. 

Upon what conditions does successful soldering depend? 

Upon the cleanliness and the contact of the two surfaces 
to be united; upon a good solder, and sufficient and proper 
distribution of heat. 

What causes porcelain facings to check and crack in 
soldering? 

Borax on the porcelain and the too suddeu heating and 
cooling of the case. 

State the cause of pits in soldering. 

The use of too little borax or borax contaminated with 
sand or grit, or keeping the solder too long under insufficient 
heat, causing it to oxidize. (Dr. Win. H. Trueman.) 

In soldering a small piece of gold to a larger piece, on 
which should the solder be placed? Why? 

The solder should be placed on the larger piece, the larger 
being harder to heat, the flow of the solder is easier directed 
towards the smaller piece. 

State which, in your opinion, is the best artificial crown 
for any of the six upper anterior teeth. Give reasons. 

Where the bite is close, a banded or partially banded crown, 
such as the Richmond, Litch or banded Logan crown, is most 
serviceable. Crowns of this style are best adapted to the 
root, possess greater strength and protect the root from 
fracture. 

Describe the method of constructing a banded Logan 
cuspid crown. 

A cap is made and adjusted to the root; it is then per- 
forated to permit the dowel of the crown to pass into the 
root. The crown is ground to fit the labial portion of the 
cap, while the lingual portion may extend one-sixteenth of 



PROSTHETIC DENTISTRY. 73 

an inch from the cap to permit of the solder. The crown 
is then removed and a piece of pure gold or platinum, 33 
gauge, burnished to the base of the crown. It is then placed 
in position on the root and the tooth and cap united with 
hard wax, after which it is removed, invested and soldered. 

Give method of preparing a root for a Richmond crown. 

The root is trimmed to within a sixteenth of an inch of the 
gum line, except the labial portion which is cut slightly below 
the gum margin. The ridge of enamel remaining upon the 
root is thoroughly removed by means of cleavers, and with a 
fine disk the sides of the root are made smooth and parallel. 
[With a root reamer or fissure drill the canal is enlarged for 
the reception of the dowel. 

Describe a Richmond crown. 

The Richmond crown consists of a gold ferrule with a 
soldered base, through the center of which a pin is attached 
by means of solder. To the cap thus made, a facing backed 
with gold or platinum is soldered. The palatal surface of the 
crown corresponds in shape to that of the natural crown. 

In soldering a Richmond crown, how may the solder be 
drawn to the front so that a perfect joint between the 
porcelain and the gold may be obtained? 

Liqiid borax is run over the labial joint and covered with 
a layer of melted wax. After the case is invested and the wax 
removed, the joint from the inside is boraxed. In soldering, 
the heat should be applied from the undersurface of the in- 
vestment and when sufficiently hot, the solder is applied and 
made to flow through to the labial edge. 

Give a method of removing a Richmond crown in order 
to repair tl\e broken porcelain. 

If the crown is set with gutta-percha, it can be removed by 
applying heat to the palatal surface. If set with cement, the 
band on the posterior surface is cut and forced away from the 
root. AVith a rose head bur the cement between the cap and 
the root is remWed. A strong instrument with the point 



74 PROSTHETIC DENTISTRY. 

bent at right angles is inserted and the crown forced ont. It 
is sometimes necessary to cut the pin. 

How would you repair a Richmond crown with a broken 
facing? 

The remains of the porcelain are removed, also the backing. 
A facing is prepared, backed and adjusted with hard wax, 
after which it is invested and soldered. 

Describe the BonwiJl crown and the method of its 
attachment to the root. 

It is an all-porcelain crown with an opening through the 
center for the passage of the supporting post. The base is 
concave and the upper portion of the opening is shaped to 
form a dovetail, which, when the crown is fixed upon its post, 
prevents its displacement. The edges of the porcelain are 
designed to rest uniformly upon the outer edge of the pre- 
pared root-surface. 

The method of its attachment consists in trimming the ioot 
face as for the reception of any post crown. By means of a 
corundum stone the crown is accurately adapted to the edges 
of the root and made to occlude properly Avith the antagon- 
izing teeth. The root canal is reamed so as to receive a large- 
sized pin and with a small wheel bur it is grooved similar to a 
screw thread. With a corundum wheel the porcelain on the 
base of the crown, except the edges that have been adapted to 
the root, is removed sufficient to admit of a thicker layer of 
amalgam than when the crown is in close contact with the root. 

Zinc phosphate is then mixed and carried to the md of the 
root-canal and the post pressed into it. The crown is now 
placed over the pin and into its proper position ; ic is allowed 
to remain until the cement is hard, when it is removed and 
amalgam packed into the canal and about the pin. The con- 
cavity in the base of the crown is also packed with amalgam 
and the crown firmly pressed into position \j means of a 
crown-driver, devised for that purpose. A fresh mix of 
amalgam is packed about the pin in the cavity on the occlusal 
surface, which when hard, is dressed and polished. 



PROSTHETIC DENTISTRY. 75 

Describe the method of constructing a porcelain=faced 
bicuspid crown. 

A shell crown is made and fitted to the root. The buccal 
portion is cut out, leaving the band intact at the gum margin 
to the depth of a sixteenth of an inch. A cross-pin facing 
is ground to fit the opening, backed with 33-gauge pure gold, 
and readjusted to the crown. The crown and facing are held 
together with binding wire wrapped directly over the facing, 
which should be protected from discoloration with asbestos 
fibre. Flux is added and the crown soldered by holding it 
over the flame of a Bunsen burner. 

Describe a method of constructing a bicuspid jacket 
crown with a porcelain facing fused to it. 

A ferrule is made of platinum plate of 30 gauge. This is 
fitted to the tooth. It is then trimmed to be even with the 
tooth crown. A piece of iridio-platinum plate is soldered to the 
band, allowing the buccal half to be free. Pure gold should 
be used for solder. The face of the cap is then cut out; the 
portion of the top plate which is free, is shaped to form a 
cusp. A facing of the proper shade and size is ground to 
fit the opening. The porcelain is now mixed and packed into the 
spaces and against the metal to which the facing is to be 
fused. The facing is then pressed into place, the case care- 
fully dried and the porcelain fused. If more body is re- 
quired, it can be added and the case re-fused. 

State the method of adding a low=fusing porcelain face 
to a gold shell crown. 

A seamless crown is made and fitted to the root. The por- 
tion of the surface of the crown to which the porcelain is to 
b* added, is crushed in with a few taps from the bench ham- 
mer; it should be sufficient to admit of a thick body of porce- 
lain. The surface is then roughened or perforated. The 
oody is mixed, packed on to the gold, dried and baked. This 
is repeated until the desired shape and size is obtained, when 
the crown may be polished. 



76 PROSTHETIC DENTISTRY. 

Describe a Mason detachable porcelain=faced crown. 
State the advantage of its use and where applicable. 

It consists of a drop-forged backing of heavy gold plate 
which has a triangular slot throughout its length, and a porce- 
lain facing with a triangular bar baked in the longitudinal 
axis of its lingual surface ; this is constructed so as to slip into 
the slot of the backing. 

The advantage of this crown is, that in case of fracture a new 
facing can be adjusted without necessitating the removal of 
the collar and post. It is applicable on all post and collar 
crowns or as dummies in anterior bridges. 

What advantage, if any, have Richmond crowns over 
others? 

They protect the root from fracture and decay and are 
stronger where an unusual stress has to be borne by the root. 

Describe fully the method of preparing a molar tooth 
for a gold crown. 

With carborundum stones and disks, the sides of the na- 
tural crown and neck of the tooth are made parallel, or the 
circumference of the crown less than that of the root. 

Describe fully a method of constructing a gold cap or 
shell crown for a molar tooth, the cusps of which occlude 
accurately with the antagonizing teeth. 

The tooth properly prepared, a measurement is taken at the 
neck of the tooth by means of the dentimeter and annealed 
brass wire No. 33 gauge. The wire is cut, straightened, laid 
on the gold and a band cut of corresponding length and wide 
enough to extend from below the gum margin to within a 
sixteenth of an inch of the opposing tooth. The band is now 
annealed, the ends are beveled and united with 20-carat 
solder. The cylinder is trimmed and fitted to the tooth, the 
joint placed so as to come on the palatal aspect. It is re- 
moved, contoured and re-adjusted; a small roll of softened 
beeswax is placed in the mouth and the bite taken including 
two or three of the adjoining teeth. This is removed and a 



PROSTHETIC DENTISTRY. 11 

plaster impression taken, in which the barrel is embedded. A 
model and an articulating model are made and mounted upon 
a crown articulator. The occluding teeth are then varnished, 
the barrel filled with soft plaster and the occlusion made. 
AVhen the plaster is set, it is trimmed sufficient to expose the 
gold rim. Cusps and sulci are then carved in such a manner 
as to occlude properly with the antagonizing teeth. The 
collar and the plaster cusps are then pressed into moldine, re- 
moved, and Mellotte 's metal poured into the mold. Annealed 
22-carat plate 30 gauge is placed on a pine block and with 
the die the cusps are swaged. It is now trimmed, and ad- 
justed to the cylinder. Both sections are pickled, the parts 
brought together and held in apposition with binding wire; 
flux is added and the parts united with 20-carat solder by 
holding them over the Bunsen flame. The crown is then 
trimmed and polished. 

How would you repair a gold cap with a hole in it? 

The crown is boiled in acid, after which the hole is filled 
with a large pellet of soft gold and solder flowed over. 

How would you remove a gold crown from a diseased 
molar tooth? 

The palatal surface of the crown is slit with either a chisel 
or cutter devised for that purpose, and the laps of gold pulled 
away from the tooth. A sharp-pointed instrument is then 
worked between it and the crown surface of the tooth, and 
with slight pressure the crown can be forced away from the 
tooth. 

Give details of constructing a gold cap for a cuspid. 

The measurement of the root to be crowned is taken with 
an annealed copper strip which is placed around the root and 
grasped firmly with pliers. The strip is removed, the surplus 
ends trimmed and the band cut through the center. The re- 
spective halves are bent over the lingual and labial forms 
of a Holingsworth mould-plate. When the proper form is 
selected, it is placed on the moulding plate with a rubber ring 



78 PROSTHETIC DENTISTRY. 

around it; into this is poured Mellotte's metal and a die of the 
two surfaces secured. Annealed 22-carat, 30-gauge gold is 
}> laced over the die and the sections swaged separately. They 
are now boiled in acid, the edge smoothed and trimmed, the 
parts brought together and held with binding wire. Flux 
is applied and the halves united with 20-carat solder. 

Describe the method of constructing a bicuspid crown 
with a porcelain front for a tooth having a vital pulp. 

The tooth is trimmed for the reception of the collar. Suffi- 
cient of the buccal surface of the tooth is removed to accommo- 
date the porcelain, care being taken not to injure the pulp. 
A seamless gold crown is then made and fitted on the tooth; 
the buccal surface is cut out, leaving intact a sixteenth of an 
inch, the portion extending above the gum line. No. 60 gold 
foil is burnished on the tooth and, while in place, the crown 
is adjusted; through the opening cut for the facing a small 
nodule of soft beeswax is forced. The crown with the wax 
and gold foil is removed and invested in a mixture of silex 
and plaster. The case is then dried, the wax thoroughly re- 
moved and low-fusing body packed into the space occupied 
by the wax and over the face of the crown. This is baked, 
after which sufficient porcelain is added to give the desired 
shape and size. It is again baked and the crown polished. 

What style of a crown would you use to restore abraded 
front teeth? 

A barrel crown of either gold or platinum with a veneer 
soldered or fused to it. 

Describe the Davis crown, State how you would adjust 
it to the root. 

The Davis crown consists of two parts : The pin, which is 
separate from the crown, and the crown itself. The crown is 
all-porcelain with an opening extending well into the body for 
the reception of the pin. In adjusting it, the edges of the 
crown are ground to fit the face of the root accurately. The 
root canal is reamed to receive the pin, which is cemented into 



PROSTHETIC DENTISTRY. 79 

the canal. The cavity in the crown is then filled with ce- 
ment and the crown placed over the pin, is forced into position. 

What is the advantage of the Davis crown? 

In case of fracture a new crown can be adjusted without 
removing the dowel. 

Describe the process of making a molar crown with a 
gold band and a saddle=back or plain rubber tooth. 

A ferrule is made as for an all-gold crown. A bite and im- 
pression are taken and the models mounted upon a crown arti- 
culator. A wire measurement is then taken of the circum- 
ference of the upper portion of the ferrule. A tooth is 
selected, the circumference of which is the same as that of the 
ferrule. The buccal face of the ferrule is cut out, except the 
slight rim of gold extending beneath the gum. By means of 
corundum wheels the edges of the porcelain are made to fit 
the edges of the gold at the cervical and approximal borders, 
care being taken to have the articulation perfect. Pure gold 
No. 35 gauge is burnished to the under-surface of the porce- 
lain ; it is now adjusted to the barrel, invested and soldered. 

Describe a method of making and attaching a swaged 
shell corner for a central incisor, the cavity of which in= 
volves both labial and lingual wall and the masticating 
surface. 

The tooth is thoroughly excavated; the enamel edges 
beveled and smoothed. A small piece of softened modeling 
compound is pressed into the cavity and allowed to harden, 
when it is removed and with a sharp-bladed instrument 
trimmed and carved to correspond to the desired shape of the 
corner. It is then pressed into " moldine " and a die of 
Mellotte's metal made. Annealed 24-carat gold 30 gauge is 
swaged; the edges are trimmed and made to slightly overlap 
the cavity margins. The shell is re-inforced with 20-carat 
solder, to which two pins, made to extend well into the cavity, 
are soldered. The corner is now polished and adjusted by 
first filling the cavity, then the shell with cement; it is now 



80 PROSTHETIC DENTISTRY. 

placed in position and held until the cement is hard. That 
which oozes out is removed and the margins coated with 
varnish. 

Describe the method of preparing a root for the recep= 
tion of a Buttner crown. 

A special set of instruments is required for this process : 
drill, root-facer and trephine. The root-facer, guided by a 
central pin, cuts the face of the root level. The drill is used 
to open and enlarge the canal, and by means of the trephine 
the neck of the root is made cylindrical. 

Describe the method of preparing and attaching a por= 
celain tip (lower third) to a central incisor with a vital 
pulp. 

The surface of the tooth is made smooth and square. To 
this is burnished a piece of platinum plate No. 35. With, the 
plate in position on the tooth, three holes are drilled as deep 
as may be done without injuring the pulp ; in each of the 
openings a post is placed and adhesive wax flowed over the 
projecting ends, attaching them to the plate. The plate is then 
carefully removed, invested, and the pins united to the plate 
with pure gold. The piece is placed on the root, the pins 
trimmed to within a thirty-second of an inch of the 
plate, care being taken to have the plate well burnished. A 
plaster impression is taken and removed with the small plate 
embedded in it, A model is made with sand and plaster, 
which when hard, is carefully removed from the impression. 
A cross pin tooth of the desired shape and size and with the 
pins close to the cutting edge is selected. The facing is then 
cut down to about the desired length and the final fitting to 
the tooth made with a fine grit stone. It is then backed 
with platinum No. 28, attached to the plate with sticky 
wax and invested in sand and plaster. When dried, the case 
is soldered with 22-carat solder. In setting it, the rubber 
dam is adjusted to the tooth, the holes in the tooth are filled 
Avith soft cement and the tip is placed in position; it should 
be held firm until the cement is hard. 



IkOSTHETIC DENTISTRY. 81 

What are the requisites of a crown? 

It must protect the root from decay and should restore the 
appearance and the function of the natural tooth. 

In bridge=work should the teeth fit the gum perfectly or 
should a space be left between the gum and the bridge? 
Explain. 

A space should be left between the gum and the teeth in 
order to facilitate cleansing. 

Describe the construction of a bridge to replace the 
inferior central incisors, the remaining teeth being sound 
and in place. 

With disks and corundum wheels the lateral incisors are 
prepared for the reception of open-face crowns which are 
made of 22-carat gold, 29 guage. The crowns are adjusted to 
the teeth, and a wax bite and a plaster impression are taken 
with the crowns in place ; when the impression is removed, the 
crowns, if not imbedded in the plaster, should be placed in 
their respective position in the impression. The model is run 
with plaster and marble dust and with the articulating model 
it is mounted on the crown articulator. Facings of the de- 
sired shape and size are selected, backed and adjusted to the 
cast with hard wax. The case is now invested, dried and 
heated, the borax applied and the case soldered. 

Describe a method of constructing a gold bridge to re- 
place lost teeth between the cuspid and second molar, both 
named teeth being in place and sound. 

The cuspid tooth is devitalized, the pulp extirpated and the 
natural crown cut off. The root is then prepared for the re- 
ception of a collar crown which is made and adjusted. The 
molar tooth is prepared and a shell crown made of 22-carat 
gold, 29 gauge. This is placed in position and a wax bite 
taken of the entire side. An impression of the antagonizing 
teeth is taken in wax and the model poured. A plaster im- 
pression is now taken with the crowns in position which 
should be imbedded in the plaster when the impression is re- 
6 



l^ 



82 PROSTHETIC DENTISTRY. 

moved. A model is then run and with the articulating model 
it is mounted on the articulator. The bicuspids and the 
molar facings are selected and ground to fit the model, the 
upper edge extending to within a few lines of the gum. 

The occluding edge of the facing — ground to within a six- 
teenth of an inch of contact with the opposing teeth — is be- 
veled toward the outer edge. 

Backings are fitted to the facings, extending from the 
cutting edge to near the gum line. Cusps for the respective 
teeth are then swaged on a die plate and fitted to the facings. 
They are united with hard wax, invested and soldered separ- 
ately with 20-carat solder, using sufficient to give the proper 
shape. When cool, they are boiled in acid and mounted on 
the cast, to which they are attached with hard wax. The 
bridge is now carefully removed from the articulator and em- 
bedded in an investment of plaster and asbestos fibre; it is 
dried, heated in the furnace, boraxed and soldered. When 
cold, it is removed from the investment, boiled in the acid, 
trimmed and polished. 

State the method of making the grinding surface of a 
bridge with one continuous piece of gold. 

The abutment crowns in place, a bite and plaster impression 
are taken and the models mounted on the articulator. Suit- 
able facings are selected, and fitted to the cast. The cutting 
edges are shortened sufficient to permit of a protecting cover- 
ing of gold. The backings are adapted, the facings invested 
and solder flowed over the backings, having the pins well 
covered with the solder. They are now trimmed, adjusted 
to the cast and a roll of softened bees-wax is placed be- 
tween the abutments and extended over the cutting edge of 
the facings. The cusps of the antagonizing teeth are oiled 
as is also the surface of the wax which is again warmed and 
the jaws of the articulator brought together. When separ- 
ated, the cusps and sulci are carved to occlude accurately with 
the antagonizing teeth. The wax cusps are then removed 
from the model and embedded in a mixture of plaster. A rim 



PROSTHETIC DENTISTRY. 83 

of thin copper about an inch in width is placed around the 
wax and in the soft plaster. When the plaster is hard, it is 
placed over a burner and gradually heated until the wax is 
soft enough to be removed. When the mould is thoroughly 
dried, it is run with Mellotte's metal. On the die thus se- 
cured a strip of annealed gold 22-carat 30 gauge is swaged. 
This is boiled in acid, the edges trimmed and the cusps re- 
inforced with 20-carat solder. It is then placed on the model 
and the facings adjusted to their proper position. The case 
is now invested and soldered in the usual way. 

Give a method of making and attaching a removable 
bridge. 

The abutments are properly prepared and collars with flat 
tops are made and cemented in place. Telescoping caps are 
then constructed and fitted over the barrel-covered abutments. 
A bit and an impression are taken, the caps being embedded 
in the impression. Models are made and mounted on the arti- 
culator. The dummies are made and soldered to the caps. 
The bridge is then trimmed and polished. The caps are 
warmed, lined with a film of gutta-percha, placed in posi- 
tion over the barrel-covered abutments and the bridge forced 
into place. 

If a bridge, extending from the canine to the third molar, 
breaks in the middle, what is the method of repairing it? 

The bridge is removed, boiled in acid and re-adjusted in 
the mouth. By means of a plaster matrix it is removed, in- 
vested and soldered. 

How should the loss of a superior lateral incisor be 
supplied? 

An impression, including the adjoining teeth, is taken and 
a die made. Gold plate, 22-carat, 29 gauge is swaged to the 
palatal surface of the cuspid and central incisor. Holes are 
drilled in the palatal surface of each tooth extending into the 
dentin, care being taken not to encroach upon the pulp; 
the openings should be well undercut and large enough to ae- 



84 PROSTHETIC DENTISTRY. 

commodate a flat-headed platinum pin. The plates are then 
placed in position, a hole corresponding to the one in the 
tooth is drilled and the pin inserted and united to the plate 
with sticky wax. The plates are removed, invested and sol- 
dered with 22-carat solder. They are then adjusted to the 
teeth and held with a little soft gutta-percha. A plaster im- 
pression is taken with the plates in position; Avhen removed, 
the plates' are placed in position in the impression and the 
model run in plaster and marble dust. A facing is selected, 
backed and fitted to the model, it is attached to the backings 
with hard wax. The case is then invested and soldered. 

Describe a method of constructing a bridge extending 
from a lower first bicuspid to a third molar, both teeth 
inclining towards each other. 

Abutment caps are constructed with square tubes soldered 
to the distal surface of the bicuspid and mesial surface of 
the molar. A bar, extending across the space, is bent so that 
the ends will slip into the tubes. The abutments are placed on 
the teeth and a bite and plaster impression taken. The 
crowns are then placed in their position in the impression 
and the models made and mounted. The bar is now adjusted 
to its place and plain rubber teeth waxed to the bar. The 
teeth and bar are removed from the cast, the case is flasked, 
packed and vulcanized. The crowns are cemented in place 
and the bar with the teeth vulcanized to it, is slipped into 
position. 

What is the object of an investment? 

The protection of the porcelain from the flame, to afford at- 
tachment, and to support in proper position the parts to be 
soldered. 

What is the best investment for crown and bridge work? 

A combination of fibre asbestos and plaster of Paris. 

Why is silver not used in crown and bridge work? 

Because it is soon corroded by the oral secretion. 



PROSTHETIC DENTISTRY. 85 

How may a badly decayed root be re=inforced or 
strengthened sufficiently to carry a dowel or pin crown? 

The decay should be removed and the tooth thoroughly 
sterilized with nitrate of silver. Small grooves are cut with 
a wheel bur in the root canal, which has been well reamed. 
The canal is then packed with amalgam and while soft, a 
steel pin is forced well up in the centre. More amalgam is 
added and banked up around the pin. The amalgam is then 
held firmly with the fingers of one hand, while the pin is 
carefully removed with the other. 

Give method of taking an impression of a root for a 
gold crown. 

An annealed copper band is shaped and placed on the root ; 
while in position, an impression is taken with plaster in a 
small tray. 

State the difference in degrees between the boiling=point 
of water and the fusing=point of gold. 

About 1804 degrees. 

Describe Brown's porcelain bridge, stating advantages 
and disadvantages. 

It consists of a rigid supporting and anchoring bar to which 
are adjusted porcelain teeth, atta'ched to the bar by means 
of porcelain fused about the parts. 

The advantages claimed for it are: that it is less liable to 
fracture than facings employed in the regular bridge; its na- 
tural appearances and cleanliness. Its disadvantage is, that 
in many cases its application necessitates the mutilation of 
sound teeth. 

How would you secure an anchoring bar to a vital tooth? 

By means of a filling of cohesive gold, which should be 
inserted with the electric mallet. In the posterior teeth 
amalgam can be used for the same purpose. 

State the method of preparing and filling a cavity in a 
porcelain tooth. 

The cavity is prepared by means of a diamond-pointed drill. 



86 PROSTHETIC DENTISTRY. 

The tooth is placed in plaster to facilitate holding it during 
the process of filling, which is done in the usual way. 

At what age is the regulating of the teeth permissible? 

At about the ninth year, or as soon as appliances can be 
used to advantage. 

State the principle of Farrar's system of regulating. 

The moving of teeth should be by force that is positive in 
character. 

Describe Dr. Farrar's appliance for moving roots for= 
ward. 

"The base of support is a transpalatal screw-jack, an- 
chored by two clamp bands that embrace the side teeth ; from 
this jack to the posterior sides of the necks of the incisors 
are two other screw-jacks to press against these front teeth. 
To hold these jacks upon them, a broad band with a U-shaped 
lug soldered on the lingual side is cemented to each incisor in 
which a bar connecting the anterior ends of the jack rests. 
To hold firmly the end of the crown of each incisor, and to 
prevent them from moving forward when the jacks are set 
at work against the necks of the teeth, the ends are tied to 
the transpalatal jack by two wire cords connected with a 
cross bar lodged in other U-shaped lugs soldered to the labial 
side of the bands." (The American Text Book of Operative 
Dentistry.) 

Describe Dr. Farrar's appliance for moving roots back. 

"The crowns are stayed by an inside rectangular frame 
resting in U-shaped lugs at the ends of the crowns and braced 
against nuts soldered to two anchor clamp bands on the side 
teeth. The roots are drawn back by a labial bow, attached to 
the clamp bands by screws." 

Describe the Jackson crib and base wire. 

It consists of a base wire. No. 13 or 14 B. & S. gauge, con- 
necting cribs placed on the two opposite molars or bicuspids, 
and bent in a bow corresponding to the lingual surfaces of 



PBOSTHETIC DENTISTBY. 87 

the teeth. To this base wire are soldered springs for moving 
teeth in different directions according to the requirements 
of the case. 

State a method of rotating a lateral incisor. 

It can be rotated by means of piano wire soldered to a band 
which is cemented to the lateral incisor, the free end of the 
wire held by a lug on the second bicuspid band. 

Describe the Angle method of retracting a protruding 
lower jaw. 

A large traction screw is attached to clamp bands which 
encircle the first lower molars. The ends of the bar are 
hooked into small staples soldered to the distal angles of 
bands upon the canines; while a piece of gold wire attached 
by solder, connects these bands and passes in front of the in- 
cisors. This appliance is used in conjunction with a metal 
cup swaged to fit the chin and connected by rubber bands 
with a cap on the back of the head. 

Describe a method of bringing into proper position a 
right upper cuspid that bites inside the circle of the lower 
teeth. 

A jack-screw extending from the palatal surface of the first 
bicuspid to the palatal surface of the cuspid is adjusted. By 
turning the screw a little each day the cuspid will be forced 
into position. 

Describe Angle's appliance for retracting a cuspid. 

Angle's drag-screw consists of a stiff wire, screw-cut at one 
end and bent into a hook at the other. Anchorage is secured 
by soldering a tube to a molar and a bicuspid band. The 
screw- cut end is passed through the tube and the nut placed 
in position. The end with the hook is slipped into a tube 
soldered to a band which is cemented on the cuspid. 

Give a method of elongating bicuspids when they fail to 
occlude properly. 

Bands to which hooks are soldered are cemented to the up- 



88 PROSTHETIC DENTISTRY. 

per and lower bicuspid teeth. A rubber band is stretched 
from the hooks on the upper bicuspids to the corresponding 
ones on the lower bands. 

Describe Dr. Case's appliance for raising the occlusion 
of the lower bicuspids. 

On each bicuspid is cemented a band with a buccal hook 
pointing downward. On the band for the molars is sol- 
dered a hollow tube. On the incisors are cemented bands with 
hooks turned upward. A labial bow of piano wire with the 
ends inserted in the tubes on the molars bands, the front 
resting above the hooks on the incisors and the sides pressed 
under the hooks on the bicuspids. 

Describe Case's retainer for the anterior teeth. 

It consists of a series of bands soldered together at their 
point of contact with an excess of solder in front. The labial 
surface of all but the end bands are cut away, so as to leave 
only a small portion between the teeth; these are filed so as 
to resemble gold fillings. The appliance is stiffened by sol- 
dering a piece of swaged plate to the lingual surface. 

Describe a simple retainer for a single tooth that has 
been rotated. 

A wire is soldered to the labial surface of a band which is 
cemented to the tooth. The wire should project so as to rest 
on the labial surface of the adjoining teeth. 

Describe an appliance for expanding or enlarging the 
arch. 

AYide bands are made for the first bicuspid and first molar 
of each side. The bands on each side are joined by a bar 
soldered to the lingual surface. This bar is made of clasp 
gold of Xo. 22 gauge and should be about one-eighth of an 
inch wide ; in this holes are punched at short intervals. 
Angle's jack-crew is then adjusted, placing the pointed end 
of the tube in a hole in the bar on one side, and one prong 
of the forked end in a hole in the opposite bar. The force 
is applied by turning the nut. 



PROSTHETIC DENTISTRY. 89 

Give the method of obtaining an impression of a per= 
forated hard palate. 

With quick-setting plaster the cavity above the roof of the 
mouth is filled even with the border of the fissure, and while 
soft, the palatal impression is taken and retained in position 
until the plaster is hard. The palatal surface of the plaster 
above the roof of the mouth should be coated with a solution 
of soap to prevent the two masses from adhering when brought 
in contact. The impression of the palate is removed in the 
usual way and with a pair of pliers the mass from the nasal 
portion is carried backward and withdrawn from the mouth. 
The two portions are then placed together and waxed. 

Give the method of taking an impression of a cleft palate. 

An impression tray of the proper size is selected; it should 
extend slightly beyond the posterior borders of the hard 
palate. It is sometimes necessary to lengthen the tray by 
means of a flap of base plate gutta-percha, which may be 
carried back as far as the uvula. Plaster of Paris mixed 
in the usual way is placed in the tray, care being taken not to 
use too much. The tray is introduced into the mouth and 
pressed up quickly and firmly, holding it in place until the 
plaster will break with a clear fracture, when it is removed. 

What is an obturator? 

It is an appliance employed to close an opening in the hard 
or soft palate. 

Define an artificial velum. 

It is an appliance made to supply the loss of the posterior' 
soft palate. 

Describe the method of constructing an obturator. 

A model having been obtained, the fissure in the hard 
palate is filled with wax. Dies are made and a gold plate 
swaged to fit the re-constructed model. The plate is provided 
with an extension at the posterior extremity which is to sup- 
port the obturator and is attached to the teeth by clasping the 



90 PROSTHETIC DENTISTBY. 

six-year molars. The plate is then fitted to the mouth and a 
loop of copper wire soldered (with soft solder) to the upper 
side of the plate and extended backward about two-thirds of 
the length of the fissure. A mass of softened beeswax is 
wrapped about the wire loop and shaped to correspond to 
the fissure. It is then slightly softened in warm water and 
placed in the mouth ; the patient is directed to swallow several 
times ; by this means the softened mass is moulded to the re- 
quired shape. When removed from the mouth, the palatal 
surface is trimmed into a continuous flat surface; the upper 
surface is treated similarly. In the region of the uvula the 
sides must be trimmed away so that they may close under 
the obturator. Plaster is then mixed and a little placed upon 
the upper side of the plate, extending from the wax bulb for- 
ward to reach the end of the fissure when placed in the 
mouth. The plate with plaster upon it, is then introduced in 
the mouth and carried into place. By this means an im- 
pression of the forward part of the cleft is obtained. Plaster 
moulds are now made and the case flasked. Before packing, 
patterns of the upper and under surfaces of the bulb are cut 
from No. 60 tin foil, and a single pattern to extent around 
the sides and end. These are reproduced from sheet rubber 
and are united to form the bulb by placing the edges tight 
together. Before finally closing, water should be introduced, 
filling the bulb about half full, care being taken that the edges 
of the rubber do not become wet. The flask is closed and the 
case vulcanized. The bulb is then fitted to the plate. A hole 
is drilled through the bulb and plate, through which an iridio- 
platinum bar is passed and soldered to the plate, the opposite 
end being screAv-cut and supplied with a nut. The surface 
of the plate, on which the bulb is to lie, is smeared with gutta- 
percha, the bulb slipped over the bar, and the nut screwed 
down until it impinges. The plate is then warmed over a 
burner, the gutta-percha softened and the nut screwed tight. 
The plate and bulb are trimmed and polished. 

Describe the method and material vou would use to se= 



PROSTHETIC DENTISTRY. 91 

cure a perfect impression of the inferior maxilla when 
fractured. 

Plaster of Paris is prepared and placed upon the oiled sur- 
face of a large impression tray. The fragments of the jaw 
should be held in position by an assistant and the tray intro- 
duced and carefully pressed into place. When the plaster is 
hardened, the tray is detached and by means of a sharp instru- 
ment the impression is cut and removed in sections. The 
pieces are replaced on the tray and held together with wax. 

Describe the method of constructing an interdental 
splint. 

The model of both jaws being obtained, they are carefully 
articulated by cutting with a small saw the lower cast at the 
point of fracture. The sections are re-arranged so as to 
bring the teeth of the two models into proper articulation. 
They are then secured with plaster and the two models 
mounted on the articulator. The interdental dovetail spaces 
are filled with soft plaster. 

The bite is opened about half an inch by means of the set- 
screw in the articulator. The teeth and a portion of the 
gums of both casts are covered with No. 60 tin foil. A layer 
of rubber is then cut so as to completely cover the foil, one 
for the upper and one for the lower cast. The rubber is 
warmed and with a hot instrument it is adapted and fastened 
to the cast. The articulator with the casts is then brought 
into proper position and united with rubber posts placed 
in the position of the cuspids and molars. With a hot 
spatula the surface of the rubber is made smooth and the 
edges fastened to the plaster. The case is now ready for 
flasking. Soft plaster is run into the interior of the moulds 
which are then embedded in a large flask containing soft 
plaster. The case is vulcanized and finished in the usual 
manner. 

State the relative merits of gutta=percha and cement 
as a retentive medium for crowns and bridges. 

The adhesive properties, as well as the hardness of oxy- 



92 PEOSTHETIC DENTISTRY. 

phosphate render it valuable in such cases as require rigidity 
and support. 

Gutta-percha is valuable in cases where removal may 
be desirable and where the retentive medium is exposed to 
the fluids of the mouth. 

Describe the Bonwill articulator. 

It is composed of brass wire and tubing, and consists of a 
base and a pair of bows. The upper bow is narrower than 
the lower bow; they are detachable by loosening the set- 
screws. At either extremity of the cross-bar is an eyelet, 
through which the "condyle" of the articulator works. 
Back of the condyle are two spiral springs which represent 
the muscles. This construction permits the side motions of 
the lower jaAv to be fairly well imitated. 

State the method of facing a black rubber plate with 
pink rubber by vulcanizing once. 

The preparatory steps for flashing and packing are the 
same as for the ordinary case. Strips of pink rubber are 
placed between the teeth, and extending from above the pins 
to the top of the rim. A layer of pink rubber, the exact size 
and shape of the palatal portion of the plate, is cut and 
placed in position, care being taken to have no spaces or 
crevices. A sheet of- black rubber is stretched to one-half 
its regular thickness. It is cut to the desired shape and size 
and placed in position over the pink; the edges should be 
neatly packed about the pins. A piece of holland is placed 
over the rubber, the flask closed, heated, and the bolts tight- 
ened. The flask is then opened, the cloth removed, and a 
narrow rim or roll of black rubber, extending from heel to 
heel of the plate, is placed at the junction of the black and 
pink rubber. The flask is closed and the case vulcanized. 

Describe the method of reproducing the rugae in a vul= 
canite plate. State the advantage. 

Heavy tin-foil is swaged or burnished upon the palatal 
portion of a model having well-defined rugae. The tin-foil 



PROSTHETIC DENTISTRY. 93 

is carefully removed and the lines of the rugae neatly filled 
with yellow beeswax. The tin-foil is then fitted to the pala- 
tal portion of the denture while it is in the lower section of 
the flask and before the upper section has been filled with 
plaster. The beeswax in the lines of the rugae prevent their 
being crushed while the tin-foil is being made to conform 
to the palatal surface of the denture. When this has been 
adjusted, the flasking is completed and the case finished. 
The tin-foil imparts to the vulcanite a polished surface, and 
no smoothing is needed on this portion of the plate. 

The advantages of the rugae on the vulcanite plate are : 
the tendency to lisp is greatly lessened, it has a more natural 
fe°ling to the tongue, and pronunciation is assisted. 

How may the extreme limit of the posterior border of 
an upper plate be determined? 

By the degree of sensitiveness of the tissues to the plate. 
The posterior border should not encroach upon the soft pal- 
ate nor should it cause discomfort to the patient. 

How would you repair a broken clasp on a rubber 
plate? 

A new clasp should be made and attached to the plate by 
vulcanizing. 

What are the uses of silex in dentistry? 

To prevent the adhesion of plaster to, and to produce a 
smooth surface on vulcanite. It is used also to unite por- 
tions of a broken plaster model. 

Describe the blowpipe invented by Dr. J. Rollo Knapp 
and state some of its uses. 

It consists of blowpipe attachments connected with a 
nitrous oxide gas cylinder, the cylinder being set upright 
and attached to an iron base, at the other end of which is 
a movable table upon which to rest the work. The blowpipe 
proper is a continuation of the outlet tube of the gas cylin- 
der. A lever- valve regulates the supply of nitrous oxide. 
Beyond this valve is the mixing chamber, to which illumin- 



94 PROSTHETIC DENTISTRY. 

ating gas is conducted from the gas-pipe through a rubber 
tubing entering the bottom of the chamber. The mixing 
chamber is provided with a gauze screen to prevent the 
flame from being drawn into the tubes. Beyond the mixing 
chamber a pipe is branched so as to afford two flames of 
different sizes. It is practically an oxy-hydrogen blowpipe. 
It may be used to melt small quantities of platinum, but it 
is especially useful in crown and bridge-work manipulations, 
where an extremely high temperature is required to fuse 
metals so quickly that the heat will not extend beyond where 
it is required. 



ORAL SURGERY 



What conditions are necessary to obtain bony consoli= 
dation after fracture? 

Accurate apposition of the fractured surfaces without the 
interposition of pieces of muscle, connective tissue or an ex- 
cessive amount of blood-clot, immobilization for a sufficient 
length of time, sufficient blood supply to both fragments, 
sufficient innervation, absence of surface inflammation and 
constitutional causes of non-union. Asepsis is greatly to be 
desired, but bony union can occur in suppurating wounds by 
a process analogous to the healing of wounds by second 
intention. 

In what stage of inflammation is cold a valuable remedial 
agent? Give reasons. 

Cold is a valuable remedial agent in the beginning of in- 
flammation since it causes a contraction of the blood-vessels 
and therefore lessens the amount of blood in the part. When 
permanently employed it dilates the vessels by paralysis of 
the muscular coat and the increased amount of blood brings 
to the part an increased quantity of leucocytes and protect- 
ive proteids. If applied for too long a time, it lowers the 
vitality of the tissues, promotes stasis, and interferes with 
the ameboid action of the leucocytes. 

At what age are the best results obtained from opera= 
tions for cleft palate? Give reasons. 

The best results are obtained by operating between the 
second and third years. It is not advisable to operate upon 
infants since they stand hemorrhage poorly, suck the stitches 
and disturb them with the tongue, and because the tissues are 

(95) 



96 ORAL SURGERY. 

delicate and friable. It should not be deferred later than the 
period indicated, as bad habits of articulation will be con- 
tracted and subsequent success, as gauged by the quality of 
the speech, is much less likely to follow. 

Differentiate lacerated and contused wounds. 

A lacerated wound is a wound produced by a tearing of 
the tissues. 

j*. contused wound is a wound produced by a bruising of 
the tissues. 

In practice the distinction is not well drawn, since the 
edges of most lacerated wounds are also more or less contused. 

State the predisposing causes of lingual carcinoma. 

Age of the patient (past 40) ; any irritation, such as a 
sharp tooth, the stem of a pipe, or a badly fitting plate; 
psoriasis and scars produced by syphilis or injury; smoking. 

What are wounds and how are they classified? 

A wound is a solution of continuity of an external or 
internal surface of tiie body. 

Wounds are classified as follows : Incised, lacerated, con- 
tused, punctured, poisoned and gunshot. 

Give varieties of fracture of the inferior maxilla. 

Through the body of the bone in the neighborhood of the 
mental foramen, at the angle or within the vertical ramus, 
through the neck of the condyle, and at the base of the 
coronoid process. 

Describe the operation for ligating the facial artery. 

After all aseptic precautions have been carried out, a 
horizontal incision, one inch in length, is made directly over 
the vessel as it crosses the lower border of the jaw immediately 
in front of the masseter. The incision divides the integument, 
the fascia, and the platysma myoides. In making the in- 
cision, the skin should be drawn upward over the bone, so 
that when the skin retracts, the scar will not be visible upon 
the face. The A'essel is ligated just as it emerges from the. 



ORAL SURGERY. 97 

substance of the submaxillary gland. The aneurism needle 
is passed from behind forward. 

What is anesthesia? 

Anesthesia is a condition of total or partial insensibility, 
particularly to touch. 

Define synovitis. Give symptoms and treatment. 

By synovitis is meant the inflammation of a synovial 
membrane. 

Symptoms. — The joint becomes the seat of lancinating pain 
and is filled with fluid. If the articulation is superficial, 
the overlying skin may be hot and hyperemic. There is a 
spasm of the surrounding .muscles, causing the joint to be 
held in that position which affords the greatest ease to the 
patient. In some cases, the muscles controlling the joint un- 
dergo a rapid atrophy. If suppuration occurs, the overly- 
ing integument becomes dusky red and edematous. The pain 
becomes throbbing in character, and the individual is fre- 
quently awakened at night by starting pains in the ex- 
tremity. The temperature is high and there is emaciation. 

Treatment. — Immobilization. In the early stages and in 
young people, cold is of value (evaporating lotions, ice bag, 
Leiter's tubes). Later on, warm fomentations may be used 
or a few leeches applied. If painful distention is present, 
some of the fluid may be aspirated under strict aseptic pre- 
cautions. Should suppuration occur, the joint must be 
opened, irrigated, and a rubber drainage tube introduced into 
the most dependent portion. 

Any underlying diathesis should receive appropriate con- 
stitutional treatment. 

Describe the operation for ligating the temporal artery. 

Make a vertical incision one inch in length, a half inch in 

front of the tragus, and just above the zygomatic arch. 

Divide skin, superficial fascia and deep fascia, and then 

feel for the pulsation of the vessel. The aneurism needle 

7 



98 ORAL SURGERY. 

is to be passed from behind forward so as to avoid the 
temporal vein and the auriculotemporal nerve. 

Give the varieties of gangrene. 

1. Symptomatic gangrene: embolic, senile, diabetic, Ray- 
naud's disease, ergotic. 

2. Traumatic gangrene : direct and indirect. 

3. Infective gangrene : acute rapidly spreading gangrene, 
hospital gangrene, necrosis of bone, noma or cancrum oris, 
carbuncle and boil. 

4. Thermal gangrene: frost-bite, burns, and scalds. 

Name the different methods for arresting arterial hemor= 
rhage. 

Direct pressure, acupressure, forcipressure, torsion, cau- 
terization, and ligation. 

Is necrosis found more frequently in the inferior or in 
the superior maxilla? Why? 

Necrosis is found rather more frequently in the inferior 
maxilla because its blood supply is not so abundant. 

Differentiate a syphilitic ulcer of the tongue from a 
traumatic ulcer of the tongue. 

Syphilitic ulcer. — There is a superficial crack or fissure 
upon the side or tip of the tongue. Such fissures may be 
multiple, chronic, or relapsing. It is common in the second- 
ary period of the disease, and is often accompanied by 
mucous patches, by similar ulcers upon the cheeks, or by 
papular eruptions upon the skin. It improves under specific 
treatment. 

Traumatic ulcer. — The ulcer is usually situated upon the 
side of the tongue, is ragged or irregular in outline, and 
is usually opposite a collection of tartar, an angle of a 
tooth, or the edge of a plate. The glands are not enlarged. 
Recovery follows the removal of the local irritant. 

Define orthodontia. 

By orthodontia is meant the correction of irregularities 
of the teeth. 






ORAL SURGERY. 99 

State the best method of sterilizing instruments. 

The best method of sterilizing instruments is to boil them 
for ten minutes in a 1% solution of sodium carbonate. 

What are the causes of secondary hemorrhage? 

Chief cause, — septic arteritis. 

Contributory causes : 1. Early absorption of ligature. 2. 
Faulty application of ligature. 3. Ligature too near a 
collateral branch. 4. A diseased condition of the arterial 
wall. 5. A state of blood unfavorable to repair of any wound 
(albuminuria or diabetes). 6. Increased blood pressure 
(plethora, Bright 's disease, fever, injudicious excitement, or 
unwise administration of stimulants). 

Define staphylorrhaphy. State the most favorable age 
for the operation. 

By staphylorrhaphy is meant the plastic operation for 
closing a cleft in the soft palate. 

The most favorable age for the performance of the oper- 
ation is between the second and third year. It is very im- 
portant that staphylorraphy should be performed before 
the child commences to talk. 

Mention two methods of preserving the aseptic char= 
acter of a wound. 

The aseptic method and the antiseptic method. 
Give etiology and treatment of syncope. 

Syncope is due to anemia of the brain produced by sudden 
failure of the heart's action. 

Lay patient flat on his back with the head low. Make 
friction over the precordial region or apply galvanism. Apply 
smelling salts to nostrils and give a little brandy as soon as 
the patient can swallow. 

Give the clinical appearance and treatment of osteoma 
of the inferior maxilla. 

Osteoma of the inferior maxilla may consist either of a 
general thickening or enlargement of the entire bone or of a 



L.ofC. 



100 ORAL SURGERY. 

local outgrowth. The tumor is extremely hard, grows slowly, 
and causes no pain unless it presses upon important sensory 
nerves. The neighboring lymphatic glands are not enlarged. 
Treatment. — These tumors are best left alone unless the 
deformity is great or the movements of the mandible are in- 
terfered with. They may be partially excised, the offending 
portions being chiselled, drilled, or ground away, or they 
may be wholly removed by excising a portion of the mandible. 

Describe suppurative cellulitis. 

The affected part is hot, tender, and infiltrated; if super- 
ficial, it looks red and angry and is brawny to the touch. 
Fever is usually present and, in severe cases, one or more 
rigors may occur. If the part is not incised, the process 
rapidly spreads throughout the entire extremity or region; 
the toxic fever rapidly exhausts the patient's strength and the 
entire subcutaneous and intermuscular areolar tissue of the 
part is destroyed. 

Define surgical shock. Give the treatment. 

Surgical shock is the immediate constitutional effect of 
an injury. 

Treatment. — When slight, rest in the recumbent posture 
and the use of some aromatic stimulant (ammonia). 
If severe, recumbent position with the head low; surround 
the patient with hot bottles (well protected) and blankets 
to maintain and bring up body-temperature. If conscious 
and able to swallow, give a little warm tea or stimulant; if 
unconscious, a small hot coffee or brandy enema, or a hypo- 
dermatic injection of ether or strychnine. Care should be 
taken not to waste vital power by over-stimulation which 
will result in excessive reaction. The intravenous injec- 
tion of normal saline solution frequently gives excellent 
results. If the shock is maintained by the presence of a 
mangled limb, it may be well to perform an amputation. 

What diseases of the tongue may be mistaken for 
carcinoma? 

Primary, secondary, or tertiary syphilis, leukoplakia, 



ORAL SURGERY. 101 

chronic glossitis, traumatic ulcers, tubercular ulcers, sarcoma, 
and actinomycosis. 

Mention two varieties of cysts of the tongue. Give 
the treatment of one variety. 

Dermoid cyst. — Retention cyst, due to the occlusion of the 
duct of a small mucous gland. 

The retention cyst is best treated by excision. 

Mention the materials employed for sutures, and de- 
scribe the twisted or hare=lip suture. 

Silk, silkworm-gut, catgut, kangaroo tendon, silver wire, 
and horse-hair. 

The hair-lip or twisted suture consists of metallic pins or 
needles thrust through both lips of the wound, the edges of 
which are kept in contact over the pins by figure-eight 
turns of silk. 

Give the etiology, clinical appearance, and the treatment 
of acute ranula. 

Acute ranula is an accumulation of saliva (from obstruc- 
tion and rupture of Wharton's duct) in a serous sac known 
as Fleischmann 's bursa (Tillaux). Duplay considers the 
acute ranula to consist of a dilatation of the duct itself. 

The cystic tumor is situated in the floor of the mouth to 
one side of the median line. It is globular, semi-transparent, 
and may attain the size of a bantam's egg, pushing the 
tongue upwards and backwards and interfering with degluti- 
tion and speech. It contains a glairy mucous fluid. 

Treatment. Excision of a portion of the anterior wall of 
the cyst and swabbing out the cavity with pure carbolic acid. 
The cavity is then packed with iodoform gauze and made to 
heal by granulation. If the condition recurs, the entire 
growth is to be excised. 

Mention the varieties of displacement in fracture of the 
inferior maxilla. Give the symptoms and treatment of 
one variety. 

Tn fractures through the angle, or lower part of the 



102 ORAL SURGERY. 

ramus, there is usually little displacement, as the masseter on 
the outer side and the internal pterygoid on the inner side, 
maintain the fragments in apposition. When the fracture 
passes through the neck of the condyle, that process is drawn 
forward and inward by the external pterygoid, whilst the 
body of the bone is freely movable antero-posteriorly, and is 
displaced toward the sound side. 

"When the coronoid process is detached, it is drawn up- 
wards by the temporal tendon, but no great displacement 
can occur, owing to the extensive attachment of the tendinous 
fibres. 

In the most common fracture, through the body of the 
bone near the mental foramen, the large anterior fragment 
is displaced downwards by the muscles passing from the 
hyoid bone to the jaw. The smaller fragment is drawn up- 
wards by the muscles of mastication and is displaced out- 
wards, so that it overlaps the anterior fragment. 

In a fracture through the body of the jaw there will usually 
be hemorrhage from the mouth, irregularity of the denture, 
crepitus, and a displacement as described above. The treat- 
ment consists of the reduction of the displacement, the appli- 
cation of a Barton bandage and the maintenance of an aseptic 
condition of the oral cavity. If necessary, Hammond's splint 
may be applied. 

Define neurasthenia and give its symptoms and treat= 
ment. 

A condition of lack of power of the nerve-centres, not de- 
pendent upon the existence of organic disease in any portion 
of the body. 

Symptoms. — Loss of weight and slight anemia, excessive 
irritability of the heart, spots of local tenderness over the 
spine, weariness upon exertion, weakness of memory, dis- 
turbance of sleep, flushes of heat, profuse sweating, and occa- 
sionally disturbances of sensation. 

Treatment. — Rest, with change of scene and diet; massage, 
out of door life, avoidance of excitement, strychnine in full 
doses, and, best of all, the " rest cure " as prescribed by Dr. 
S. Weir Mitchell. 



ORAL SURGERY. 103 

Define odontoma. Give the classification, clinical ap- 
pearance, and the treatment of odontoma. 

An odontoma is a tumor originating from some abnormal 
condition of the teeth or teeth germs. 

1. Epithelial odontoma. Originates from enamel organs, 
usually affects lower jaw, forms tumor of great size, and 
as a rule runs a perfectly benign course. The only treat- 
ment consists in complete removal of the affected portion of 
the jaw. 

2. Follicular odontoma (dentigerous cysts). More common 
in lower jaw, tumor, at first, hard and solid, but subse- 
quently gives egg-shell crackling and even fluctuation. A 
permanent tooth will be found missing, and there is no 
history of its having been extracted. The treatment consists 
in excising a portion of the wall of the cyst from the mouth 
and extracting the misplaced tooth. The interior of the 
cyst is then to be thoroughly scraped, flushed with an anti- 
septic solution and packed with gauze. 

3. Fibrous odontoma. Occurs rarely in rickety children; 
there is thickening and condensation of the connective tissues 
around a tooth-sac. Treatment, thorough removal. 

4. Radicular odontoma. A tumor composed of cement de- 
veloping at the root of a tooth. It causes severe pain and 
may result in septic inflammation of the surrounding bone. 
Treatment, thorough removal. 

5. Composite odontoma. — These may be very large and 
resemble osteomata of the antrum. Treatment, thorough 
removal if causing trouble. 

Give the etiology, clinical division, pathologic classi= 
fication, and the treatment of tumors. 

Etiology. — Injury or irritation, infection, heredity, fetal 
residues. 

Clinical Division. Benign and Malignant, 

Pathologic Classification. 

I. Mesoblastic or Connective Tissue Tumors. 

A. Those conforming to the types of fully formed con- 
nective tissues : 



104 ORAL SURGERY. 

1. Fibroma. 

2. Lipoma. 

3. Chondroma. 

4. Osteoma. 

5. Myxoma. 

B. Those conforming to the types of the higher connective 
tissues : 

1. Myoma. 

2. Angioma. 

3. Lymphangioma. 

4. Neuroma. 

C. Those conforming to the types of embryonic connective 
tissue : Sarcoma. 

II. Epiblastic and hypoblastic tumors, i. e., those conform- 
ing to the type of Epithelial Tissues : 

1. Papilloma. 

2. Adenoma. 

3. Carcinoma. 

III. Tumors composed of Epiblastic, Hypoblastic and 
Mesoblastic Elements: Teratoma. 

Treatment. In Benign Tumors, removal if annoying or if 
they show a tendency to become malignant . 

In Malignant Tumors, secondary deposits should be re- 
moved with the primary growths. If complete removal is im- 
possible they had best be left alone. 

Give the causes and treatment of spasmodic respiratory 
failure. 

Laryngitis, laryngismus stridulus, tetanus, and hydrophobia. 

Treatment. In tetanus and hydrophobia treatment is 
practically useless. It consists of the administration of 
chloral between, and of chloroform during the attacks. 

In laryngitis and laryngismus stridulus, place child in 
hot bath. Give syrup of ipecac to produce vomiting and 
place hot compresses about the throat. If child cannot swal- 
low, tickle throat with finger to produce emesis. 

Describe the operation of extracting molar teeth. Men- 



ORAL SURGERY. 105 

tion accidents that may occur in the extraction of these 
teeth. 

First and second upper molars. The operator stands at 
right of patient, passing the left arm around the head, and 
holding the lip out of place with the fingers of the left hand. 
In using the cow-horn forceps, take care to thrust the points 
of the horn directly into the interspace and then carry the 
flat, blade along the palatine fang as high as possible. A few 
rocks of the tooth inward and outward combined with direct 
force in the line of its long axis will cause it to give way. 

First and second lower molars. Position of operator as 
before. Use the cow-horn forceps for lower molars, and so 
apply them that the closure of the handle forces the points 
into the interspace where they will meet. If closing the 
handle does not loosen the tooth, gently rock the forceps in- 
ward and outward until the tooth is felt to yield, when it is at 
once to be lifted from its socket. 

In extracting the third molar, an appropriate forceps must 
be selected and the traction made in the axis of the single 
curved root, usually backwards and upwards or downwards, 
as the case may be. 

The accidents of extraction are : Laceration of gum, frac- 
ture of alveolar process, paralysis, excessive hemorrhage, 
loosening or breaking of other teeth, and luxation of the in- 
ferior maxilla. 

Define replantation of teeth, transplantation of teeth, 
and implantation of teeth. 

By replantation is meant the return of a tooth to its na- 
tural socket after extraction. 

By transplantation is meant the transference of a tooth 
from its original socket to one existing in another jaw. 

By implantation is meant making a socket in a jaw where 
none exists and inserting a tooth into it. 

Give a differential diagnosis of traumatic ulcer of the 
tongue and epithelioma of the tongue. 

The traumatic ulcer is usually situated upon the side of 



106 



ORAL SURGERY. 



the tongue opposite a mass of tartar, an angle of a tooth, or 
the edge of a plate. The ulcer is ragged, irregular, without 
induration (unless very chronic,) and the lymphatic glands 
beneath the lower jaw are not enlarged. 

Epithelioma occurs in middle-aged or elderly individuals. 
The ulcer has a widely indurated base, thick everted edge, 
an irregular warty surface, a watery discharge, and there is 
an enlargement of one or more of the submental glands. 

Give a differential diagnosis of suppuration of the maxil- 
lary sinus and tumor of the maxillary sinus. 



Suppuration. 

History of preceding alveolar ab- 
scess or rhinitis. 



Tumor. 

No such history. 



Causes same deformity, but to a 
less degree. 



Exophthalmos, encroachment upon 
nasal fossae, a flattening of roof 
of mouth, and a projection of 
the cheek below the malar bone. 



Intermittent discharge of pus from Xo suppuration, 
nostril of affected side. 



Fever. 



Xo fever 



If acute, the cheek is red, hot, and 
swollen, and the part is painful. 



May be painful or painless. 



Exploratory puncture reveals pus. Exploratory puncture does not re- 
veal pus. It may reveal blood 
(sarcoma), or exploratory punc- 
ture may be impossible (oste- 
oma). 

Give the etiology, diagnosis, and treatment of cystic 
dilatation of Steno's duct or of Wharton's duct. 

Etiology. — A salivary calculus may be formed within 
Steno's duct and completely occlude its lumen. 

Diagnosis : Painful swelling in region of parotid gland, 
pain increased by the ingestion of food. The calculus may 



ORAL SURGERY. 107 

be readily detected by probing the duct, or it may be felt 
through the tissues of the cheek. 

Treatment. — Remove the calculus by an incision into the 
overlying buccal mucous membrane. 

State how syncope spontaneously arrests hemorrhage. 

By reducing the force of the blood current and thus per- 
mitting coagulation to occur within the wounded vessel. 

Describe the Hammond wire splint and state in what 
class of fractures it can be successfully employed. 

It consists of a firm wire collar or framework which en- 
circles the whole series of teeth in the lower jaw. It is ac- 
curately fitted to the jaw and fixed by several short wires 
passing from the lingual to the buccal wire between the teeth. 

It can be successfully employed in a fractured mandible 
where there is much displacement. 

Define fracture. Give the local and the constitutional 
causes of non=union of fractures. 

A fracture is a sudden solution of continuity in a bone, 
usually due to excessive violence. The local causes of non- 
union are : 

1. Faulty apposition. 

2. The interposition of fluid, muscular or aponeurotic tissue, 

or pieces of bone between the ends of the fragments. 

3. Want of rest. 

4. Defective blood supply. 

5. Defective innervation. 

6. Inflammation on the surface of the limb. 

7. Faulty treatment, and, 

8. Local affections of bone (malignant tumors, destruction 

of the periosteum by inflammation). 
The constitutional causes are : 

1. General constitutional weakness. 

2. Osteomalacia. 

3. Scurvy. 

4. Syphilis. 



108 ORAL SURGERY. 

5. Senility (probably). 

6. Pregnancy, and 

7. The cancerous cachexia. 

Differentiate sapremia, septicemia and pyemia. 

Sapremia (septic intoxication) is a wound fever due to the 
absorption of the products of putrefaction into the system. 
It is a toxemia or condition due to chemical poisoning, and 
the blood is not infective. 

Septicemia (septic infection) is a wound fever due to the 
introduction into the blood and tissues of bacteria which 
rapidly multiply. The blood is infective, since it contains 
not only the toxins but also the organisms which produce 
them. 

Pyemia is a wound fever developed during the process of 
suppuration and is due to the absorption of pyogenic organ- 
isms into the circulation. Clinically, pyemia is septicemia 
plus metastatic abscesses. 

State precautions that should be taken when operating 
on syphilitic patients. 

Any cracks or abrasions upon the hands of the operator 
should be protected by a collodion dressing and the hands 
should be encased in a pair of sterile rubber gloves. At 
various intervals during the operation, the hands should be 
immersed in an antiseptic solution and then rinsed in sterile 
water. At the conclusion of the operation the hands should 
be well scrubbed, soaked for several minutes in a bichloride of 
mercury solution (1-1000), and then washed in sterile water. 

In trifacial neuralgia caused by infection, malaria, or 
grip, what division of the nerve is usually involved? 

The first or ophthalmic division. 

What produces mechanical asphyxia during ether or 
chloroform anesthesia? 

Mechanical asphyxia is produced by the tongue falling 
backward over the glottis. 



ORAL SURGERY. 109 

Give the differential diagnosis of fracture and dislocation. 
Fracture. Dislocation. 

Preternatural mobility. Immobility. 

Crepitus. No crepitus. 

The deformity usually returns im- The deformity does not usually re- 
mediately after it has been cor- cur after it has been corrected, 
rected. 

Give the anatomic and the clinical varieties of hemor- 
rhage. 

The anatomic varieties of hemorrhage are the arterial, the 
venous, and the capillary. 

The clinical varieties of hemorrhage are primary hemor- 
rhage, intermediate or reactionary hemorrhage, and second- 
ary hemorrhage. 

State why an alveolar abscess may cause suppurative 
inflammation of the maxillary sinus. 

Because the suppuration is in the floor of the sinus and 
may point towards its cavity or cause a suppurative inflamma- 
tion by contiguity of structure. 

Mention the predisposing and the exciting causes, to- 
gether with the local and the constitutional symptoms of 
inflammation. 

The predisposing causes include everything which lowers 
the general resistance of the body; such as Bright 's disease, 
diabetes, anemia, tuberculosis, and chronic alcoholism. 

The exciting causes are traumatism, heat, cold, chemical 
agents, and bacteria. 

The local symptoms are redness, heat, pain, swelling, and 
modified function. The constitutional symptom is fever. 

Give the pathology, symptoms and treatment of in- 
flammation. 

Pathology. — There are three sets of changes: 
1. Changes in the blood vessels and in the circulation. 
The blood vessels dilate. The current is at first more rapid 



110 ORAL SURGERY. 

but soon becomes slower, so that an axial stream (red blood 
corpuscles) and a periaxial stream (white blood corpuscles 
and blood placques) may be differentiated. In addition to 
dilating, the vessels become elongated and tortuous. The 
current finally becomes so sluggish that it moves onward with 
each systole and backward with each diastole (oscillation). 
This is followed by stasis. 

2. Exudation of serum and transmigration of the leucocytes. 

3. Changes in the tissues themselves. These consist of a 
multiplication of the fixed and wandering connective tissue 
cells. 

Symptoms. — The local symptoms are redness, heat, pain, 
swelling, and modified function. The constitutional symp- 
tom is fever. 

Treatment. — The local treatment includes rest, elevation, 
the use of heat or cold, local blood-letting, astringents, anti- 
septics, counter-irritation, compression, and massage. 

The constitutional treatment comprises good hygiene, a 
light nutritious diet, purgatives, venesection, antipyretics, 
hypnotics, analgesics, stimulants, and tonics. 

Give the cause and treatment of noisy movements of 
the temporo=maxilIary articulation. 

Cause. — Laxity of ligaments and weakness of surrounding 
muscles. In some cases it is due to a displacement of the 
inter-articular cartilage. 

Treatment. — Tonics, electricity. The wearing of an occi- 
pito-mental sling. If the inter-articular cartilage is displaced 
an incision may be made into the joint and the cartilage 
sutured in its normal position. 

Define septic intoxication. Give treatment. 

Septic intoxication is a form of poisoning resulting from 
the absorption of the products of putrefaction. 

The local treatment consists of the thorough removal of the 
source of infection and of the antiseptic treatment of the 
wound. 

The constitutional treatment must be of a supporting char- 



ORAL SURGERY. Ill 

acter. Alcohol and hypodermatic injections of strychnine 
are to be recommended. Enteroclysis or hypodermoclysis. 

Define stomatitis. Mention the varieties of stomatitis 
and give treatment of one variety. 

By stomatitis is meant an inflammation of the oral mucous 
membrane. 

The varieties are catarrhal, aphthous, ulcerative, para- 
sitic, gangrenous, mercurial, syphilitic, and scorbutic. 

Treatment of ulcerative stomatitis : Correct the hygiene. 
Tonic doses of quinine. Touch ulcers with nitrate of silver. 
Use as a mouth wash a solution of potassium chlorate or 
hydrogen peroxide. 

Differentiate acquired cleft palate and congenital cleft 
palate. 

Congenital cleft palate exists at birth and is due to want 
of union of the two palatal segments of the maxillary 
processes. 

Acquired cleft palate is produced at some period of extra- 
uterine life by losses of substance resulting from injury 
or syphilis. 

How would you treat persistent bleeding after lancing 
the gums of a child? 

By pressure with compresses soaked in peroxide of hydro- 
gen; by packing the incision with a pledget of cotton satur- 
ated with phenate of soda or a solution of tannic acid. In 
some cases the lips of the wound may be temporarily ap- 
proximated by a suture. Monsel's salts and solutions are 
only to be used in extreme cases, since they impair the vitality 
of the tissues and increase the danger of secondary hemor- 
rhage. In addition to the local treatment, one of the follow- 
ing hemostatics may be administered : 

Tr. ergot (gtt. V, repeated in one or two hours'). Tr. 
erigeron canadensis (gtt. 1, in water every minute until 
bleeding ceases, or until twenty doses have been taken), 
gallic acid (gr. 1, every two hours'). 



112 ORAL SURGERY. 

What treatment would you pursue in excessive hemor- 
rhage after tooth extraction? 

Remove all clots and pieces of root, plug the tooth-socket 
with a strip of gauze saturated with peroxide of hydrogen, 
and reinforce the plug by means of a supporting pad. Should 
this fail, a plug may be made of gauze, the meshes of which 
contain tannic acid or alum. The advantage of the clot 
formed by tannin is that it is insoluble in the blood. Per- 
chlorid of iron and Monsel's solution should not be employed 
on account of their injurious effects upon the tissues and the 
danger of secondary hemorrhage. In obstinate cases, the 
hemorrhage may always be controlled by packing the tooth- 
socket with a strip of gauze, in the meshes of which rapidly 
setting plaster-of-Paris has been incorporated. A pledget 
of cotton saturated with adrecalin chloride (1-1000) may 
also be used. 

Give one of the causes of antral disease, its diagnosis, 
and treatment. 

An alveolo-dental abscess discharging into the antrum. 

The diagnosis will be made by the presence of the follow- 
ing signs and symptoms : Pain over the affected region and 
the discovery of the offending tooth or root. Tenderness upon 
percussion of the antrum. The escape of pus through the 
nostril of the affected side. If the antrum contains a con- 
siderable quantity of pus, it will be opaque to transmitted 
light, as compared with the opposite side. The examination is 
made by taking the patient into a dark room and introducing 
a small incandescent lamp into the mouth, which is then closed. 
If the pus can find no outlet, the floor of the orbit will be 
pushed up, causing exophthalmos, the nasal fossae will be 
encroached upon, and there will be edema of the cheek. 

The treatment consists in the establishment of efficient 
drainage and the thorough irrigation of the cavity of the 
antrum. This may be accomplished by extracting the offend- 
ing tooth or root and enlarging the opening into the antrum. 
The antrum may also be entered above the root of the second 



ORAL SURGERY. 113 

bicuspid tooth, about one inch above the border of the gum. 
The opening into the antrum must be kept open by a gauze 
or tubular drain until the discharge entirely ceases. During 
this time the cavity of the antrum may be irrigated, — at first 
daily, and subsequently at longer intervals. 

How would you treat a case of external fistula with ad- 
hesion from an alveolar abscess? 

The entire fistulous tract must be dissected out and all 
cicatricial tissue removed. The necrotic bone must be burred 
away until healthy bone is reached. After the hemorrhage 
has been arrested the adjacent skin is to be loosened up 
and a flap slid over the site of the bone lesion, so that the 
cutaneous wound shall not directly overlie the wound in the 
bone. 

How would you diagnose and treat hypertrophy of 
the gums, and in what class of persons, as to age and 
mentality, does it occur? 

Diagnosis. — Diffuse, spongy, bleeding overgrowth of gums. 
Teeth show that they have been greatly neglected and are 
covered with accumulated deposits. The affection occurs after 
second dentition, usually between the ages of 18 and 25, in 
those who are ignorant and careless in their personal hygiene. 

Treatment. — Remove all deposits. Clean teeth. Give 
antiseptic mouth washes. Instruct in care of mouth, and, if 
necessary, leech, incise, or excise redundant tissue, or galvano- 
cautery may be used. 

How wouEd you treat luxation of the inferior maxilla? 
Describe the lesion and treatment anatomically. 

The mechanism is as follows : When the mouth is opened 
the condyle slides forward upon the eminentia articularis 
and only a slight traumatism is necessary to displace it still 
further forward into the zygomatic fossa. The inter-articular 
cartilage may or may not follow the condyle. 

The luxation may be unilateral or bilateral, more frequently 
the latter. The mouth cannot be closed and the lower jaw 
projects anteriorly beyond its normal position. A hollow 
8 



1 14 ORAL SURGERY. 

may be felt just in front of the tragus, in the position nor- 
mally occupied by the condyle. The condyle may be felt 
in front of this hollow. If the finger is inserted into the 
mouth, the coronoid process may be felt in an abnormal posi- 
tion beneath the zygoma. If the dislocation is unilateral, 
the symptoms are less marked, the jaw is more mobile, and 
the chin is displaced towards the sound side. 

Treatment. — All that is needed is to depress the condyle 
"below the level of the eminentia articularis, when the mas- 
seter, temporal and internal pterygoid muscles readily draw 
it back into the glenoid cavity. The patient is to be seated 
in a chair; the surgeon stands in front of the patient and 
presses downward upon the molar teeth with his thumbs, which 
are guarded with a towel. This pressure is continued in a 
downward and backward direction until the condyle clears 
the eminentia articularis, when the chin is raised by the 
fingers. The jaw is then to be kept at rest for four or five 
days by a Barton bandage. 

Give briefly your method of procedure in the treatment 
of a compound fracture of the inferior maxilla. 

The mouth, or the external wound, is to be kept as aseptic 
as possible. In ordinary cases, an external moulded splint 
may be applied to the chin, and the lower jaw held against 
the upper one by means of a Barton or a four-tailed bandage. 

The fragments may be held in place by a wire collar en- 
circling all of the teeth of the lower jaw. This collar is to 
be accurately fitted, first to a cast of the jaw and then to the 
jaw itself, and fixed by several wires passing from one-half to 
the other, between the teeth. 

If the teeth are defective, Kingley's splint may be employed. 
This consists of a vulcanite splint fitted over the alveolar pro- 
cess. Curved metal bars are attached to the front of the 
splint and extend backward over the cheeks from the angles 
of the mouth. The splint is kept in position by a bandage 
passing over the bars and under the chin. This splint will 
immobilize the fragments, even when the mouth is opened. 

In obstinate cases the fragments may be wired. 



ORAL SURGERY. 115 

Give the diagnosis and treatment of a dentigerous cyst. 

Diagnosis : These cysts are usually encountered in young 
individuals, but may occur in later life. They are far more 
common in the lower than in the upper jaw. At first the 
tumor is hard and solid, but as the bone expands it becomes 
thinned, and palpation reveals egg-shell crackling or even 
fluctuation. Upon examination of the denture, one of the 
teeth will be missing and there will be no history of its 
extraction. 

Treatment, — Excise a portion of the wall of the cyst 
(through the mouth) and extract the misplaced tooth. The 
interior of the cyst should then be scraped, irrigated, and 
packed with iodoform gauze. 

How would you diagnose and treat epulic tumors? 

Diagnosis. — Benign or fibrous epulis appears as a red, 
fleshy mass, smooth or lobulated, elastic to the touch and 
probably showing some superficial ulceration. It is a pain- 
less tumor of slow growth. 

Malignant or myeloid epulis forms a soft, rapidly grow- 
ing, painful tumor, dusky red in color, and soon ulcerating. 

Treatment. — The best treatment for fibrous epulis is to re- 
move the growth, together with that portion of the alveolus 
from which it takes its origin. If necessary, a tooth on 
either side of the tumor must be extracted, each socket cut 
through vertically with a saw, and the incisions united be- 
low with a chisel. In this manner, a quadrangular piece of 
the alveolus is removed without interfering with the con- 
tinuity of the jaw. 

In malignant epulis, it is necessary to operate as early as 
possible and to carry the bone incisions quite wide of the 
margin of the tumor. If the tumor is large, it may be neces- 
sary to remove the entire thickness of the lower, or the 
palatal segment of the upper jaw, as the case may be. 

What is a ranula? 

A ranula is a retention cyst, due to the obstruction and 
dilatation of one of the ducts of the sublingual or submaxil- 
lary gland. 



116 ORAL SURGERY. 

What do you know about aphthae and their treatment? 

The term "aphthae" is an old one and includes aphthous 
stomatitis, ulcerative stomatitis, thrush, and cancrum oris. 

Aphthous stomatitis. — Seen in nursing children. Inspec- 
tion reveals numerous small round vesicles on the cheek, lips, 
and tongue; the vesicles soon break, leaving shallow ulcers 
with a red areola. 

Treatment. — Sterilize the milk. Correct any gastric dis- 
turbance. Use a mouth wash of boric acid. 

Ulcerative stomatitis. — Attacks children and adults when 
in poor health or subjected to bad hygienic surroundings. 
Inspection reveals linear ulcers with gray sloughing bases. 
The sub-maxillary glands are swollen. In severe cases, loos- 
ening of teeth and necrosis of bone may follow. 

Treatment. — Correct hygiene. Tonic doses of quinine. 
Touch ulcers with nitrate of silver. Use as a mouth wash a 
solution of potassium chlorate or hydrogen peroxide. 

Parasitic stomatitis (Thrush). Inspection reveals numer- 
ous white elevations, which on removal leave a raw surface. 
Microscopic examination reveals the saccharomyces albicans. 

Treatment. — Correct the hygiene. Treat any gastric dis- 
turbance. Tonics. Some antiseptic mouth-wash, such as so- 
lutions of borax, boric acid, or hydrogen peroxide. 

Gangrenous stomatitis (Cancrum oris). — Usually seen in 
debilitated children and after one of the specific fevers, par- 
ticularly measles and whooping cough. The cheek is the part 
affected. Externally, it is swollen, hard, red, and glazed; 
internally, an irregular sloughing ulcer is noted. 

Treatment, — Good hygiene and stimulants. Chloroform 
the child and excise the gangrenous area, cutting widely into 
healthy tissue. The edges of the wound are then cauterized 
with fuming nitric acid, bromine, or the actual cautery. The 
resulting deformity must be treated later by a plastic 
operation. 

Describe trismus and how it differs from tetanus. 

Trismus simply means a spasmodic locking of the jaws. It 



ORAL SURGERY. 117 

may have its cause in associated dental lesions, causing irri- 
tation of the nerves of the part ; it is also a symptom of tetanus. 
Tetanus is an acute infectious disease, due to the bacillus 
of tetanus and characterized by tonic spasms with clonic 
exacerbations. The spasms also affect the muscles of the trunk. 

What is a traumatic lesion? 

A traumatic lesion is a solution of continuity due to injury. 

By what surgical operation would you abort an im= 
pending alveolar abscess? 

Make a slight cut with a sharp scalpel through the soft 
parts at the apex of the affected tooth. Pierce the outer 
plate of bone with a spear-pointed drill, thus entering the 
region in which the suppuration is impending. This wound 
should be kept patulous for several days. 

What are the indications for the use of the lance in de= 
ciduous dentition? 

The lance should never be used until the appearance of the 
white line, which is due to the pressure exerted by the erupt- 
ing tooth. Lancing should never be performed unless re- 
flex disturbances are produced. 

What anatomical irregularity of the inferior third molar 
tooth frequently presents itself in extraction? Anticipat- 
ing this condition, how would you extract it? 

The roots of the inferior third molar are almost always 
fused and curve backward. This throws the tooth against 
the second molar. Always endeavor to determine the course 
of the root, and then make traction in a corresponding direc- 
tion, usually upwards and backwards. 

Name some of the forms of sutures employed in the 
closing of surgical wounds, and what substances are used? 

The interrupted, the continuous, the mattress, the quilled, 
and the shotted suture. 

The materials employed are silk, silkworm-gut, cat-gut, 
kangaroo tendon, and silver wire. 



118 ORAL SURGERY. 

What is torsion, and when is it preferable to other means 
in arresting arterial hemorrhage? 

By torsion is meant the twisting of an artery until its 
middle and internal coats are lacerated. 

It is preferable to other means in plastic operations, where 
it is not considered desirable to leave too many ligatures be- 
hind. It is also preferable where aseptic ligatures cannot 
be obtained. 

When it is surgically necessary to make an incision 
through a muscle and a choice exists for carrying the in= 
cision parallel or transverse to the fibres of the muscle, 
which way would you adopt, and why? 

Make the incision in the direction of the fibres. The reason 
for this is that fewer fibres will be severed and the function of 
the muscle will be practically unimpaired. 

What is a sequestrum? 

A sequestrum is a piece of dead bone resulting from necrosis. 

At what point is the trunk of the facial nerve most liable 
to injury? If severed, what change occurs? 

At its exit from the stylo-mastoid foramen. If severed, a 
paralysis of the muscles of expression of the affected side is 
produced. The folds and wrinkles are obliterated upon the 
paralyzed side. The eyelid cannot be completely closed. On 
attempting to laugh or show the teeth, the muscles of the non- 
paralyzed side alone are contracted, and marked asymmetry 
results from the drawing over of the opposite side. The 
lips cannot be closed firmly, and whistling is impossible. 
Food collects between the cheek and the teeth, owing to the 
paralysis of the buccinator muscle. 

What is hare=lip? Describe a remedial operation and 
give the best age for its performance. 

A hare-lip is a congenital fissure of the upper lip, which 
may extend for a variable distance through the tissues. 

Rose's Operation. The incision extends from the apex of 
the cleft, or from within the nostril, in a concentric manner 



ORAL SURGERY. 119 

so that a slight angular projection is formed to constitute a 
prolabium. This is done on each side and, where the nose 
is much flattened, more tissue is removed from the outer than 
from the inner side, so that when the parts are sutured to- 
gether, the nostrils become as nearly symmetrical as possible. 
By this means, the depth of the lip is increased to allow of 
subsequent contraction ; the vermilion borders must be accu- 
rately approximated. Two deep silkworm-gut sutures should 
be introduced, one just above the red margin and one close 
to the nose. Cat-gut sutures are used to bring the margins of 
the wound together accurately. The dressing consists of 
gauze and collodion. The gauze is cut in the shape of a 
paddle, the broad ends being fastened to the cheek. This 
should be so applied as to prevent tension upon the wound. 
The silkworm-gut sutures are removed upon the fourth day. 
The best age for the performance of the operation is from 
6 weeks to 3 months. 

Define ankylosis. Give an example. 

Ankylosis is a condition of partial or complete immobility 
of a joint, resulting from some preceding inflammation of the 
articular structures. As an example might be given that 
form which is seen in the elbow joint after fractures into the 
articulation, and the subsequent period of enforced rest. 

How are fractures classified? 

Simple. — Not communicating with the external air. 

Compound. — Communicating with the external air. 

Comminuted. — A number of small fractures. 

Complicated. — Associated with a dislocation or with a lacer- 
ation of the main arterial or nervous trunk. 

Fractures are also divided into complete and incomplete. 

According to the line of fracture, they are called longitu- 
dinal, transverse, oblique, stellate, etc. 

Describe several methods for arresting hemorrhage in 
general. 

Ligation. — Make an incision at a slight angle to the line of 
the artery. Expose the sheath. Make as small an opening 



120 ORAL SURGERY. 

in the sheath as possible and pass a ligature about the vessel 
by means of an aneurysm needle. Tie the ligature tight 
enough to lacerate the inner and middle coats. 

Torsion. — Dissect the end of the artery free from the sheath 
for half an inch. Seize- it transversely with a hemostatic 
forceps, and then twist the free end of the artery by means 
of a second hemostatic forceps until the internal and middle 
coats are lacerated. 

Arrest capillary hemorrhage by filling the wound with hot 
water (125° P.)-. 

Give the etiology, clinical appearance, and the treat= 
ment of spongy gums. 

Etiology. — Stomatitis, systemic derangements of any kind, 
from mild fevers to acute diseases, uncleanliness, calcareous 
deposits around the necks of teeth. 

Clinical appearance. — The gums appear swollen and flabby 
around the necks of the teeth. They have a peculiar spongy 
appearance and their margins are dotted and streaked with 
bright red spots and lines. They bleed upon the slightest 
provocation. 

Treatment. — Removal of exciting cause, cleanliness, local 
blood-letting, the use of antiseptic mouth-washes, and sys- 
temic treatment according to condition of general health. 

Give the etiology, pathology and treatment of perice= 
mental abscesses. 

Etiology. — Infection from the root or from a pocket of pus 
(as in pyorrhea alveolaris) . A deposit of uric acid upon the 
root may irritate the surrounding tissues and lessen resist- 
ance to infection. 

Pathology. — The same as that of any other abscess. 

Treatment. — Secure free drainage for pus, render the ab- 
scess cavity as aseptic as possible, and prescribe an antiseptic 
mouth wash. 

Give the etiology, clinical appearance, and treatment of 
arsenic necrosis of the alveolar process. 

Etiology. — The arsenic usually gains access to the alveolus 
from an application made to the pulp. 



ORAL SURGERY. 121 

Clinical appearance. — A red tumefied area in the centre 
of which a slough is located. The process generally extends 
down into the alveolus and affects the septa between the teeth. 

Treatment. — Removal of necrotic tissue. The local ap- 
plication of sesqui-oxide of iron has-been highly recommended. 
Repeated syringings and antiseptic mouth washes. 

Give the method of removing a broken bur or nerve 
broach from a pulp canal. 

Drill around the bur with a fine fissure drill ; iodine may be 
applied and the part rusted out; sulphuric acid may be used 
to remove some of the tooth structure, or an attempt may 
be made to draw out the bur with a barbed Donaldson 
broach. 

Give the causes, pathologic conditions, and the symp= 
toms of traumatic dislocation. 

Causes. — The application of external violence and muscular 
force, acting alone or in combination. 

Pathologic conditions. — The ligaments are partially or 
completely torn. In closely fitting joints (particularly hinge- 
joints), the bony surfaces are frequently fractured. The 
cartilages may be bruised or partially detached and the neigh- 
boring muscles and tendons lacerated or displaced. Sur- 
rounding vessels and nerves are frequently injured and the 
area involved is always infiltrated by a considerable effusion 
of blood. 

Symptoms. — Pain, bruising, and swelling of the soft tissues. 
Deformity, since the articular end of the bone is displaced into 
a new position where it may often be felt and sometimes seen. 
Restricted mobility of the affected joint. True crepitus is 
not present unless a fracture co-exists. 

Give the diagnosis, prognosis, and treatment of moist 
gangrene of the pulp. 

Diagnosis. — If there is an outlet for the escape of the gases 
of decomposition, pain is not necessarily experienced. Or- 
dinarily, however, the condition causes more or less intense 



122 ORAL SURGERY. 

pain, which is usually of a throbbing and heavy character. If 
inflammation has spread to the surrounding tissues, the ap- 
plication of heat may cause an increased amount of pain. A 
foul-smelling odor is constantly present. 

Prognosis. — Not necessarily bad. The tooth may be saved 
in a majority of cases. 

Treatment, — Removal of all decomposed parts and pro- 
ducts, disinfection of pulp canal, hermetical sealing of apex 
of the tooth, and filling of the pulp canal. 

Give the etiology, diagnosis, and treatment of acute 
nonpurulent marginal gingivitis. 

Etiology. — Mechanical or thermal irritants (such as rough 
edges of an overhanging filling) , rough treatment in excavat- 
ing or filling a cavity, overheating while drying a cavity, fric- 
tion while excavating with bur, or cutting down of fillings 
with sand-paper discs, careless use of ligatures (particularly 
when they are left upon the tooth for some time), the use of 
some strong caustics, or other drugs. 

Diagnosis. — ^Severe pain, usually of a throbbing character 
and other local signs of inflammation. The tooth is slightly 
loose, and protrudes somewhat from its socket. 

Treatment, — Removal of cause, local blood-letting, paint 
parts affected with iodine. 

Give the clinical appearance and the treatment of syph= 
ilitic interstitial gingivitis. 

Inflammation, attended with superficial ulceration of 
mucous membrane and general oozing of a grayish- white color. 

Treatment. — Iodides internally. Antiseptic mouth-washes 
locally. 

Describe the " direct method " of producing artificial 
respiration. 

In the direct method, the air is warmed and pumped into 
the lungs. The apparatus required is a pair of bellows, a 
face mask, and intubation tubes (in case the mask does not 
suffice). There should be a metal tube, with an opening 



ORAL SURGERY. 123 

in it, set in the rubber tubing, so that the operator can allow 
the escape of any excess of air blown by the bellows. If 
the mask is used a ligature should be passed through the 
tongue so that it may be readily held forward. If the air 
cannot enter the lung, intubation is to be performed, and 
there will be no difficulty. A respiratory rate of 16 to 20 a 
minute should be maintained. If there is no apparatus for 
warming the air, the temperature of the room must be raised 
to at least 85° F. 

Give the etiology, pathology, symptoms, and treatment 
of hyperemia of the pulp. 

Etiology. — Irritation of bacteria, lactic acid, traumatism, 
exposure, denudation of root, and irritation from a filling. 

Pathology. — Practically that of a beginning inflammation. 
When cut into, it bleeds, rather freely. 

Symptoms. — Pain, increased by percussion, or by the appli-. 
cation of either hot or cold substances. 

Treatment. — Local and general sedatives. Counter-irrita- 
tion. If pulp does not respond, local blood letting. As a 
last resort the pulp may be destroyed. 

What precautionary measures should be observed in 
the ligation of arteries? 

Asepsis, avoid wounding important surrounding structures, 
make as small an opening as possible in the sheath, never tie 
near a collateral branch (or if forced to do so, tie branch 
also), and be sure that the ligature damages the inner and 
middle coats sufficiently to insure the obliteration of the 
vessel at that point. 

Give the treatment of septic wounds. 

Cleanse the wound as thoroughly as possible, syringe with 
hydrogen peroxide, and irrigate with bichloride (1-1000). 
If the septic condition of the wound is marked, solutions of 
chloride of zinc should be applied to all of its recesses. If 
the wound is large and irregular, rubber drainage tubes 
should be introduced into the most dependent positions. If 



124 ORAL SURGERY. 

the wound is small, gauze drainage may suffice. The best 
dressing is one of wet bichloride gauze. The constitutional 
treatment should be of a supporting character. 

Give the etiology, symptoms, and treatment of acute 
periostitis of the inferior maxilla. 

Etiology. — Traumatism, extension from a contiguous in- 
flammation (such as an alveolar abscess), the exanthemata 
(particularly measles and scarlet fever). It may also be 
caused by general conditions, such as rheumatism, gout, or 
pyemia. 

Symptoms. — The ordinary phenomena of acute inflamma- 
tion. The pain is of an intense aching character, worse at 
night, and increased by pressure. If the outer surface is 
involved, and the process go on to suppuration, a brawny 
swelling develops which softens in the center, the overlying 
skin becoming reddened and edematous. "When the abscess 
is opened, bare bone is felt, and the greater portion of the de- 
nuded structure dies. 

Treatment. — Eest, leeches, and fomentations locally, if seen 
early. A good purge should be given, and any underlying 
diathesis treated. If suppuration is threatened, a free in- 
cision should be made down to the bone. If necrosis has 
occurred, the parts must be dressed antiseptically, until the 
sequestrum is detached. If the sinus opens internally, anti- 
septic mouth-washes. 

Give the etiology and treatment of epistaxis. 

Etiology. — Traumatism, ulcers or tumors of the nasal sep- 
tum, rupture of varicose veins in mucous membrane of sep- 
tum, cerebral congestion, hemophilia, purpura, scurvy. 

Treatment. — In the majority of cases there is a local cause. 
If the bleeding point is detected, it should be touched with a 
pointed gal vano- cautery or with a swab saturated with a so- 
lution of chromic acid. Cold may be applied to the root of 
the nose and to the nape of the neck. If the bleeding point 
cannot be located, the anterior nares should be packed with 
strips of aseptic gauze saturated with hydrogen peroxide. If 



ORAL SURGERY. 125 

the hemorrhage still continues and the blood drips into the 
nasopharynx, the posterior nares must be plugged with the 
aid of Bellocq's sound or a rubber catheter. 

Describe the necessary preparation of patients for gen- 
eral anesthesia by ether or chloroform. State what re=» 
medies and instruments should be at hand. 

The patient should be examined as carefully as though he 
were an applicant for life insurance, and all organic diseases 
should be excluded. This includes physical examination of 
the lungs, heart, abdomen, etc, and chemical and microscopical 
examination of the urine. The night before the anesthesia, 
the patient should receive a half ounce of Epsom salts, and 
on the morning of the operation, the lower bowel should be 
emptied by enema. Just before the anesthesia, all loose bodies, 
false teeth, etc., should be removed from the mouth. No food 
should be taken for at least six hours before the anesthesia. 

Instruments and remedies. — Sterile hypodermatic syringe 
and sterile solutions of atropine sulphate, strychnine sulphate, 
nitro-glycerine. Brandy, ammonia, tongue forceps, and 
mouth gag. Tracheotomy instruments, a battery, and an ap- 
paratus for forced artificial respiration should always be 
within reach in a hospital. 

Give the treatment of wounds of the tongue. 

Arrest hemorrhage by exposure to the air, ice, hot water 
or ligation. If wound is small, sutures are not required. If 
large, deep-seated sutures should be introduced and the ends 
tied with more than ordinary care, since the motions of the 
tongue are apt to loosen the suture. An antiseptic mouth- 
wash should be prescribed. 

Define scarification. Give the method of this operation 
and state the results obtained, mention the necessary pre- 
cautions to be observed in scarification. 

By scarification is meant the operation of making numerous 
small superficial incisions. 

The incisions should be parallel, arranged in the form of 
a lozenge, and extend almost through the skin. 



126 ORAL SURGERY. 

The results obtained are bleeding and the relief of tension. 
The necessary precautions to be observed are the details 
of rigid asepsis. 

Mention three tumors of antrum. Give treatment. 

Osteoma, sarcoma, and carcinoma. 

Treatment. — The osteoma requires no treatment unless it 
presses upon important structures, or causes great deformity, 
when the offending portions of the tumor may be removed. 
Before such a partial operation is done, however, malignancy 
must be absolutely excluded. If a sarcoma or carcinoma can 
be thoroughly removed by an excision of the superior max- 
illa, this operation is indicated. If the malignant growth 
can not be thoroughly removed, the toxins of erysipelas may 
be injected. 

Give the local treatment of hemorrhage. 

Exposure to air, cold, hot water, position (usually eleva- 
tion) , direct pressure, styptics, cauterization, acupressure, 
forcipressure, torsion, arid ligation. 

Give treatment of injuries of the mouth caused by car= 
bolic acid. 

Apply alcohol as quickly as possible to dissolve excess of 
carbolic acid. An antiseptic mouth-wash should then be used. 

Give the diagnosis and treatment of papillomata of the 
gums. 

Diagnosis. — It is an innocent epithelial tumor consisting of 
a fibrous stroma which contains blood-vessels, lymphatics, and 
an epithelial covering peculiar to the part from which it 
springs. The tumors are generally multiple, wart-like 
growths, usually soft and seen upon the mucous membrane. 
They do not, as a rule, give pain, and are either smooth, 
rounded or of cauliflower shape. They are generally very 
vascular and bleed quite freely. Treatment. — Immediate and 
thorough removal since they show a most pronounced tend- 
ency to become malignant. 



ORAL SURGERY. 127 

Describe the technic of ligation of arteries. 

Thoroughly asepticize the part. Make an incision over the 
line of the artery. It is best to make this incision at an angle 
of five degrees to the line of the vessel. Divide the structures 
layer by layer, avoiding important vessels and nerves. After 
dividing skin, superficial and deep fascia, the pulsations of 
the vessel should be sought for. When the sheath of the vessel 
is reached, it should be opened as far away from the vein as 
possible (example, open carotid sheath upon inner side). 
This opening in sheath should be just large enough to allow 
room for the aneurism needle. In passing the aneurism 
needle always go from the most difficult to the least difficult 
side, and never lift the artery up from its bed to a greater 
extent than is absolutely essential. Before tying the ligature, 
be sure that it controls the circulation. In tying the ligature 
exert an equal amount of force upon both ends. After the 
vessel is ligated, the cutaneous wound is sutured and an 
aseptic dressing is applied. 

Give the differential diagnosis of ozaena and empyema of 
the antrum. 

In ozaena, the offensive discharge proceeds from both 
nostrils, and the nasal mucous membrane is atrophic. The 
maxillary sinuses transmit light when the patient is in a dark 
room with an incandescent lamp in the mouth. There is an 
absence of any inflammatory symptoms in the tissues over- 
lying the antrum. 

In empyema of the antrum, the discharge proceeds from the 
nostrils of the affected side ; the nasal mucous membrane 
upon the opposite side may be normal ; and the diseased maxil- 
lary sinus is more opaque to transmitted light than is the nor- 
mal antrum. There are inflammatory symptoms in the tissues 
overlying the antrum. The cause of the empyema (such as an 
alveolar abscess) may be found. 

Give the diagnosis and clinical appearance of myeloid 
sarcoma. 

Mveloid sarcoma alwavs grows from bone. It affects the 



128 ORAL SURGERY. 

long bones (particularly the upper end of humerus and tibia, 
lower end of femur). It most commonly affects individuals 
between 10 and 40 years of age. but it may occur in old age. 
The tumor is one of rather slow growth ; it may pulsate, fluc- 
tuate in certain portions of its extent, or give rise to egg- 
shell crackling. 

Give treatment of fracture of superior maxilla. State 
the complications that may arise. 

Correct any displacement; as a rule, all the treatment re- 
quired is to keep the patient quiet and apply cooling lotions 
to the part. The patient should be fed through a tube if the 
palatal process is involved. A dental plate should be applied 
to a broken alveolus. 

The complications that may arise are severe hemorrhage, 
suppuration (empyema of antrum), and necrosis. 

Give the clinical appearance, the symptoms and treat- 
ment of necrosis caused by an impacted wisdom tooth. 

The gums are usually discolored, slight bleeding is common, 
pus exudes from numerous openings over affected area. Pain 
may or may not be present. If the condition is allowed to per- 
sist the general health is impaired. 

Treatment. — Remove cause by extracting the malplaced 
tooth: antiseptic mouth- washes should be freely employed. 
The necrosed portions of the alveolus should be freely removed. 

Give the diagnosis and treatment of fracture of the in- 
ferior maxilla. 

Crepitus may be obtained. The condyle is usually drawn 
forwards and inwards by the external pterygoid, while the 
body of the bone is freely movable antero-posteriorly, and is 
displaced toward the fractured side. 

Treatment, — Barton's bandage. Intermaxillary splints are 
deservedly unpopular. The most perfect results are un- 
doubtedly obtained by wiring. 

Differentiate neuritis and neuralgia. 

Bv neuritis is meant the inflammation of a nerve. 



ORAL SURGERY. 129 

By neuralgia is meant severe paroxysmal pain along the 
course of a nerve, and not associated with demonstrable 
structural changes in the nerve. 

The pain of neuritis is increased by pressure; the pain of 
neuralgia is frequently relieved by pressure. A differential 
diagnosis is sometimes impossible. 

Give the etiology and clinical features of epithelioma of 
the lip. 

Etiology. — It is commonly stated that this tumor is due to 
the irritation produced by smoking a short clay pipe, which 
is allowed to rest on one or the other side of the lip near the 
angle. It may also originate opposite a projecting rough 
or carious tooth. 

Pathology. — The affection may be a typical malignant ulcer, 
a wart-like growth subsequently becoming fungus and ul- 
cerated, or a chronic infiltration leading to an irregular, nodu- 
lar thickening. Sections of the growth show an abundance of 
1 ' epithelial pearls. ' ' 

Clinical features. — Almost always affect lower lip. Karely 
met with in women (1 in 20). Occurs past middle life. Sub- 
mental and sub-maxillary glands not implicated for three or 
four months. Sore develops slowly. Sharp burning or lan- 
cinating pains. Odor often extremely offensive. 

Why should the hands be disinfected before a surgical 
operation. Describe the method used. 

Because the epidermis always contains pathogenic bacteria. 

Furbinger's method. — Hands and forearms are scrubbed 
continuously for five minutes with soap and aseptic nail-brush. 
The nails should be thoroughly cleaned and trimmed short. 
The hands are then plunged into absolute alcohol for at least 
one minute, and then are plunged while wet into a hot sub- 
limate solution (1-1000) and thoroughly scrubbed with a 
nail-brush for at least one minute, particular attention being 
directed to the nails. 

A better method is that of Kelly : — The hands and forearms 
are cleansed as before with soap and water and the nails 
9 



130 ORAL SURGERY. 

cleaned and pared. The hands and forearms are then im- 
mersed in a saturated solution of potassium permanganate un- 
til they are stained a deep mahogany red, or almost black. 
They are then immersed in a saturated solution of oxalic acid 
until they are completely decolorized. The oxalic acid is 
then washed off in sterile water. 

Describe the methods used in plastic surgery. 

Displacement. — Stretching or sliding of tissues. 1. Simple 
approximation after freshening the edges. 2. Sliding into 
position after transferring tension to adjoining localities. 

Interpolation — Borrowing material from adjacent regions, 
from a limb or from another person. 1. Transferring a flap 
with a pedicle. 2. Transplanting without a pedicle. 

Retrenchment. — Removing redundant material and causing 
cicatricial contraction. 

Describe local anesthesia. State the precaution neces= 
sary in producing it. 

Local anesthesia is best effected by the use of cocaine, 
and may be employed with safety when the cocaine can be con- 
fined to a limited area. The part, say a finger, is asepticized 
and a stout ligature or fillet placed about its base. The cocaine 
is then injected between the layers of the skin and also in the 
vicinity of the digital nerves. The entire finger will be 
anesthetized within three or five minutes. 

Precautions. — Asepsis — Never risk the absorption of an 
amount of cocaine which exceeds the normal dose. At the 
conclusion of the operation, loosen the ligature and then 
tighten it again after five or ten seconds. Repeat at intervals 
so that the cocaine in the tissues will not all be absorbed at one 
time. 

Give the clinical appearance of squamous lesions of 
syphilis in the mouth. 

The epithelium is whitish and opaline resembling a surface 
that has been touched by nitrate of silver. If eroded, the 
surface is red and smooth after the superficial epithelium has 



ORAL SURGE RY. 131 

desquamated. The patch is always circular or regularly oval 
aud the derma is thickened upon its surface. 

Give a differential diagnosis of an abscess, a cyst and 
a fatty tumor. 

An abscess is characterized by redness, heat, pain, swelling, 
fever, fluctuation, pointing, and the hypodermatic needle re- 
veals pus. 

A cyst is characterized by an absence of inflammatory symp- 
toms, unless it is inflamed. Fluctuation is present and the 
hypodermatic needle reveals a non-purulent fluid. A super- 
ficial cyst can be better outlined than is the case with an 
abscess. 

A fatty tumor is inelastic and doughy to the touch. It is 
adherent to the skin and, when it is moved, causes a dimpling 
of the overlying integument. There is an absence of in- 
flammatory symptoms. 

State a method of sterilizing sponges. 

The sponges should be placed in a muslin bag and well 
pounded to remove all particles of sand and other foreign 
materials. They are then rinsed out in water several times. 
A very good way is to place them in a basin, or pail, and al- 
low T the water to run in upon them from a tap for several 
hours. They are next soaked in a saturated solution of per- 
manganate of potassium, are afterwards decolorized in a so- 
lution of oxalic or of sulphuric acid, and are then left for 
twenty-four hours in an aqueous solution of hydrochloric acid, 
made strong enough to taste slightly sour. After this, they 
are again soaked in water until the washings are clear. They 
are next placed in a bichloride solution (1-500) for twelve 
hours, and finally are rinsed in warm water and preserved 
in covered glass jars containing a three percent, aqueous so- 
lution of carbolic acid, the solution being changed every week. 

What class of patients should not be anesthetized by 
(a) nitrous oxide, (b) chloroform, (c) ether? 

(a) Those with diseased blood vessels. Those in whom com- 
plete muscular relaxation is desired. 



132 ORAL SURGERY. 

.(b) Those with myocardial disease, 
(c) Those with bronchitis or Bright 's disease. 

Give reason for removing a blood clot from the surface 
of a wound. 

The chief reason for removing a clot is that it is capable of 
forming a most excellent culture medium for the growth of 
bacteria. Its presence consequently favors the development 
of sepsis. If the clot is not removed by the surgeon, it will 
be removed by nature, since it is nothing more nor less 
than a foreign body. 

Give the etiology and treatment of erosion. 

Etiology. — Acids attacking the necks of the teeth. The 
acid may proceed from the buccal glands or be regurgitated 
from the stomach. 

Treatment. — Applications of milk of magnesia, chalk, or 
some such alkaline substance. Correct any digestive defect 
and destroy the glands by the cautery, if they can be definitely 
located. The eroded places should be filled. 

Give the method of operation for exposing the inferior 
dental nerve. 

Incision, two inches in length, along the lower border of 
the jaw, beginning slightly behind the angle and well under 
the border. The upper edge of the wound is displaced up- 
ward over the ramus, the Masseter muscle is separated from 
the bone with a periosteal elevator, and a %-inch trephine 
applied one inch and a quarter above the angle. This ex- 
poses the nerve at its entrance into the inferior dental fora- 
men. The nerve may' be brought to the surface by a small 
hook or, the incision may be prolonged above and parallel to 
the edge of the jaw and the canal for the nerve laid open all 
the way to the mental foramen. 

What dangers may result from punctured wounds? 
Give treatment. 

The greatest danger is sepsis. Another is tetanus. A 
lesser danger is injury of deep structures. 



ORAL SURGERY. 133 

Treatment. — Secure efficient drainage and pack the wound 
so as to make it heal up from the bottom. Infection with 
tetanus should be guarded against by opening up all parts of 
the wound so that the oxygen of the air may gain free access. 

Describe Barton's bandage. 

The roller should be two inches in width and six yards in 
length. The initial extremity of the roller is placed on the 
head just behind the mastoid process. The bandage is then 
carried under the occipital protuberance, obliquely upward, 
under and in front of the parietal eminence, across the vertex 
of the skull, then downward over the zygomatic arch, under 
the chin, thence upward over the opposite zygomatic arch 
and over the top of the head, crossing the first turn as nearly 
as possible in the median line, and thence carrying the turns 
of the roller under the parietal eminence to the point of com- 
mencement. The bandage is then passed obliquely around 
under the occipital protuberance and forward under the 
ear to the front of the chin, thence back to the point from 
which the roller started. These figure-eight turns over 
the head and the circular turns from the occiput to the chin 
should be repeated, each turn exactly overlapping the pre- 
ceding one until the bandage is exhausted. 

Differentiate an ulcer and a fistula. 

An ulcer is a solution of continuity of the skin or mucous 
membrane due to molecular death of the part. 

A fistula is a suppurating tract connecting a cutaneous or 
mucous surface with a normal cavity of the body, or connect- 
ing two normal cavities. Strictly speaking a fistula always 
has two openings. 

Give the diagnosis of ulcerating gumma of the oral 
cavity. 

Preceding history of syphilitic infection and the presence 
of an inflammatory swelling, the surface of which is ulcer- 
ated. The ulcer is deeply excavated, the edge is undermined, 
the surrounding tissues are hyperemic, and there is a tough 



134 ORAL SURGERY. 

or soft tenacious slough adherent to its base. There is no 
glandular involvement, as a rule; the sore will heal under 
specific treatment and leave a depressed scar or a perforation. 

Give the differential diagnosis between malignant and 
non=ma!ignant tumors of the upper jaw. 

Malignant tumors grow rapidly, give metastasis, are pain- 
ful, recur after removal, may ulcerate, and finally cause death. 

Non-malignant tumors grow slowly, do not give metastasis, 
are not painful (except by pressure), do not recur after re- 
moval, rarely ulcerate, and do not cause death (except me- 
chanically) . The malignant tumors of the upper jaw are of 
more frequent occurrence than are the benign. 

Give the direction for diagnosis of mercurial stomatitis. 

The diagnosis is made by observing the following points: 
The individual may work in mercury or have been taking the 
drug internally. There will be tenderness of the gums, mani- 
fested by bringing the teeth forcibly together, redness of the 
gums near the insertion of the teeth, a metallic taste, profuse 
salivation, fetor of breath, the tongue may be reddened, 
swollen, and ulcerated, and protrude from the mouth. In 
severe cases, ulceration of the mucous membrane, loss of teeth, 
and necrosis of the jaw may result. 

Describe a four=tai!ed bandage. 

This bandage is prepared by taking a portion of a roller 
bandage, three inches wide and one yard in length, and split- 
ting each extremity up to within two inches of the centre. 
The undivided portion of the bandage is placed upon the 
point of the chin. The two lower tails are then drawn up 
and tied over the vertex while the two upper tails are secured 
behind the occiput and then, to prevent slipping, these ends 
are knotted to the ends of the former. 

What precaution should be taken in extracting molars 
and bicuspids of the inferior maxilla? 

The usual antiseptic precautions, such as sterilization of 
instruments, and cleansing of parts by germicidal solutions. 



ORAL SURGERY. 135 

The selection of a proper forceps, the history as to previous ex- 
traction, whether difficult or a tendency to hemophilia, and 
above all, keep in mind the fact that fracture may occur 
either in the body or in the alveolar process if violence is 
used. The jaw may also be dislocated. The proper motion 
for loosening root attachments should be applied and some 
guard placed over the upper teeth to prevent breaking them. 
Be prepared to treat shock and hemorrhage. 

Give the pathology and treatment of epithelioma. 

Patholog t y. — Squamous epitheliomata are nodular or wart- 
like elevations of the skin or mucous membranes tending to 
superficial ulceration. The microscope reveals branching 
columns of epithelial cells extending from the papillae of the 
skin into the deeper structures. "Cell-nests" are frequent. 
Involvement of the lymphatic glands is less marked than in 
the remaining forms of carcinoma. 

Cylindric epithelioma. — Found in gastro-intestinal tract 
and in uterus. They are composed of acinus-like tubular 
structures, frequently composed of a number of layers of epi- 
thelium, the outer layer often being distinctly columnar. 
Later on, the acini become filled with epithelial cells of vari- 
ous shapes and the cylindric character is lost. They more 
nearly resemble the glandular cancers in their general char- 
acteristics than does the squamous variety. 

Treatment. — Thorough excision of the involved tissue wher- 
ever found. If a squamous epithelioma is local beyond doubt, 
and there be no lymphatic involvement (as in rodent ulcer), 
the growth may be destroyed by Michel's or Bougard's paste. 

Describe palliative treatment of malignant tumors of 
the mouth. 

The palliative treatment of malignant tumors of the mouth 
consists in keeping the buccal cavity as aseptic as possible 
by means of antiseptic mouth-washes. Local anesthetics 
(cocaine, menthol) are employed. Morphine is administered 
and, in some cases, it has been advised to divide the lingual 
nerve. If the case is one of sarcoma, Coley's fluid may be 
tried. The X-ray is a recent addition. 



136 ORAL SURGERY. 

Give the treatment of a case of non=union in fracture of 
the inferior maxilla. 

Make incision along lower border of the body of the jaw, 
expose fragments, remove any intervening tissue, freshen 
edges, and wire together. In some cases it may suffice to rub 
the ends of the fragments together and then apply a Ham- 
mond splint. 

Give treatment of a lacerated wound. 

If the wound can be thoroughly cleansed and the edges 
have not been markedly contused, such a wound should be 
sutured and a wet bichloride dressing applied. If the wound 
cannot be thoroughly cleansed or if the edges are contused, 
clean the wound as thoroughly as possible, irrigate with a 
bichloride solution (1-2000), and apply warm antiseptic fo- 
mentations until all sloughs have separated. The wound 
should then be treated like any granulating surface. 

What is arthritis? Give treatment. 

By arthritis is meant an inflammation of a joint which in- 
volves all the structures of which it is composed. 

Treatment of Acute Arthritis.^In early stage, elevate the 
limb, immobilize absolutely, and put in such position that, if 
ankylosis occurs, the part will be of some use to the patient. 
Fomentations or an ice-bag may also be applied. As soon as 
symptoms of approaching suppuration appear, open joint 
freely in one (or better two) places, and wash out with 
some sterile or antiseptic solution (normal saline solution or 
sublimate 1-8000). Maintain fixation, continue irrigation 
until all symptoms of inflammation have disappeared, and 
look after the general health. If ankylosis occurs in a faulty 
position, resection of the joint may be required. 

How would you arrest hemorrhage from the tongue? 

Hemorrhage from the tongue may be arrested by exposure 
to the air, by ice, hot water, ligation, suture, and the cautery. 

Give etiology and treatment of false ankylosis. 

Etiology. — Inflammation outside of the joint, disuse. 



DEAL SURGERY. 137 

Treatment. — Where inflammation has been cured, massage 
and passive motion, the alternate hot and cold douche, and 
graduated exercise. If due to disuse, exercise, massage and 
galvanism. 

Define neuritis. Give cause and treatment. 

By neuritis is meant the inflammation of a nerve. 

Causes. — Inflammation, exposure to cold, some abnormal 
condition of the blood induced by rheumatism, chronic al- 
cholism, diabetes, etc. 

Treatment. — Keep part at rest. Apply blisters along the 
course of the nerve. The administration of small doeses of 
bichloride of mercury is sometimes of benefit, Treat any 
local cause or constitutional dyscrasia. It may be necessary 
to control pain by hypodermatic injections of morphine. 

When should a sequestrum be removed? 

A sequestrum should be removed as soon as it has se- 
parated. If the sequestrum is central (as in inferior maxilla), 
it should be left until the involucrum becomes sufficiently 
strong, the case meanwhile receiving appropriate antiseptic 
treatment. In such an instance, etc., the sequestrum acts as 
a splint. 

Define asphyxia. Give treatment. 

Asphyxia is suffocation. The suspension of vital pheno- 
mena which results when the lungs are deprived of oxygen. 

Treatment. — Remove any local cause. If impossible to re- 
move cause (in the larnyx for example), quickly perform 
tracheotomy below obstruction. After obstruction is removed 
or circumvented, artificial respiration is always indicated. If 
no local obstruction, artificial respiration from beginning; 
strychnine, atropine or probably cocaine should be given by an 
assistant while the operator is performing artificial re- 
spiration. 

How should chloroform be administered? Ether? What 
accidents may occur? Give treatment. 

Chloroform should be administered in free admixture with 
air (chloroform vapor 5%, air 95%). 



138 ORAL SURGERY. 

Ether should also be administered by the open method (ether 
vapor 95%, air 5%). 

Accidents. — Death from cardiac or respiratory paralysis, 
mechanical asphyxia, congestion of brain, or by the entrance 
of vomited material into the larnyx. 

Treatment. — Failure of respiration is treated by with- 
drawal of anesthetic, clearing out throat and pulling forward 
of tongue, the performance of artificial respiration, the ex- 
hibition of pungent aroma tics (ammonia), the hypodermatic 
injection of strychnine, atropine, or cocaine, the alternate 
douche of hot and cold water, and the use of the ''electric 
brush. ' ' 

Failure of circulation. — Withdraw the anesthetic, invert 
the patient, give hypodermatic injections of whiskey and 
strychnine, and perform artificial respiration, clearing out 
the mouth and holding the tongue forward. 

Describe the operation for removing calculi from the 
salivary duct. 

The calculus is located by means of a probe and the pal- 
pating finger: the duct is incised and the calculus removed. 
If the calculus is situated in the substance of the submaxil- 
lary gland, total removal of the gland may be necessary. In 
some cases the calculus may be seen projecting from the main 
duct of a gland, in which case it may be removed without 
incision. 

How are the wounds of arteries classified? 

Incised, lacerated, contused, punctured, poisoned, and 
gun-shot. 

They are sometimes divided into those in which the artery 
is completely divided and into those in which the artery is 
only partially divided. 

What is the difference between a traumatic and a con= 
genital dislocation? 

A traumatic dislocation is one produced by the application 
of external violence and muscular force, acting alone or in 
combination. 



ORAL SURGERY. 139 

A congenital dislocation is a malformation of a joint which 
exists at birth. 

Describe Gibson's bandage, 

The roller should be two inches in width and six yards in 
length. The initial extremity of the roller should be placed 
upon the vertex of the skull in a line with the anterior por- 
tion of the ear; the bandage is then carried downward in 
front of the ear to the chin, passed under the chin, and 
carried upward on the same line until it reaches the point 
of starting. The same turns are repeated until three com- 
plete turns have been made. The bandage is then continued 
until it reaches a point just above the ear, where it is re- 
versed, carried backward around the occiput, and continued 
around the head and forehead until it reaches its point of 
origin; these circular turns are continued until three turns 
have been made. "When the bandage reaches the occiput, hav- 
ing completed the third turn, it is allowed to drop down to 
the base of the skull, and it is then carried forward below 
the ear and across the chin, being brought back upon the 
opposite side of the head and neck to the point of origin; 
these turns are repeated until three complete turns have been 
made, and upon the completion of the third turn, the band- 
age is reversed and carried forward over the occiput and vertex 
to the forehead, and its extremity is here secured with a pin. 
Pins should also be applied at the points where the turns 
of the bandage cross each other. 

Give the etiology, diagnosis, and treatment of tetanus. 

Etiology. — The infection of a wound with the bacillus tetani. 
It is more common in hot climates, in dark-skinned races, 
and in those who are employed about stables. Hygienic errors 
favor development, particularly the overcrowding of sick and 
wounded in a limited space. 

Diagnosis. — Trismus, opisthotonos, emprosthotonos, or 
pleurosthotonos. The spasms are tonic in character with 
clonic exacerbations. Constipation and retention of urine are 
present. The mind is clear, there is a hypersecretion of 



140 ORAL SURGERY. 

sweat, and little or no fever. It may be possible to discover 
the source of infection. 

Treatment. — Preventive treatment consists of applying the 
principles of antisepsis to every wound encountered. 

Local treatment. — Antiseptic treatment of wound. 

Symptomatic treatment. — Chloroform during the exacer- 
bations of the spasm and chloral between the exacerbations. 
The introduction of food into the stomach by stomach tube, 
and the evacuation of the rectum and bladder at regular in- 
tervals. Calabar bean has been highly recommended. 

Specific treatment. — The administration of the anti-toxin, 
which is best done by trephining and introducing it beneath 
the dura mater. The results obtained in man are anything 
but promising. 

What is pyorrhea alveolaris? Give the etiology and 
treatment. 

Pyorrhea alveolaris is an inflammatory condition of the 
margins of the gums, accompanied by a muco-purulent dis- 
charge, which arises from pockets or pouches extending for a 
greater or less distance along the roots of the teeth. 

Etiology. — Gout, uric acid, diabetes, certain conditions of 
diet, and irregularities of the teeth might be mentioned as pre- 
disposing factors. It is always preceded by an excessive de- 
posit of tartar, beneath which bacterial infection occurs. 

Treatment. — Removal of tartar and application of astrin- 
gents and antiseptics, preferably peroxide of hydrogen. 
These applications must be made to all parts of the pouches 
or pockets. Sulphuric acid has been recently recommended. 
The treatment is prolonged and tedious. In many cases the 
teeth have been sacrificed. 

Define a cyst. Mention three divisons of cysts and give 
the etiology and treatment of one division. 

By a cyst is meant a more or less rounded cavity with a dis- 
tinct lining membrane, distended with some fluid or semi- 
solid material. 

1. Cysts formed by the distension of pre-existing spaces. 



ORAL SURGERY. 141 

2. Cysts of embryonic origin. 

3. Cysts of new formation. 

Etiology. — Dermoids may be due to the persistence of 
epithelial cells, in the deeper tissues, in situations where 
fleshy segments coalesce during fetal life. They may also be 
due to the persistence of certain tubular canals (thyro- 
glossal duct, post-anal gut). 

Cysts of embryonic origin (dermoids) are to be removed by 
careful dissection. 

What are aseptic wounds? Describe an aseptic wound. 

Aseptic wounds include all which are preserved from con- 
tamination by poisonous bacterial products, whether such 
poison come in contact with the wound directly or be gener- 
ated in it by the action of germs that gain access to it. 

In an aseptic wound the process of healing is undisturbed, 
union occurs by first intention, there is no suppuration and no 
visible sign of inflammation. 

How should a penetrating wound of the temporo=maxil= 
lary articulation be treated? 

If the wound is small and there is reason to believe that it 
was made by an aseptic instrument, the skin should be 
thoroughly cleansed and an antiseptic dressing applied. A 
careful watch is then kept upon the condition of the joint 
and the temperature of the patient; as soon as signs of acute 
arthritis manifest themselves, free incisions are to be made 
into the joint, so as to relieve tension and allow of irrigation. 

If the wound was inflicted by a dirty instrument, the wound 
should be enlarged, if necessary, so that its depths may be 
carefully examined and thoroughly cleansed. The cavity 
should be irrigated and drainage inserted. If acute arthritis 
supervenes, it must be treated in the usual way. 

Where are salivary calculi most frequently found? Give 
treatment. 

Salivary calculi are most frequently found upon the necks 
of the teeth opposite to the salivary ducts and in the duct 
of Wharton. 



142 ORAL SURGERY. 

Treatment. — Removal and the regular use of Philipp 's milk 
of magnesia. If protruding from orifice of the duct, they 
may simply be extracted. If within the duct, they should 
be cut down upon and removed. 

How should a salivary fistula be treated? 

This affection practically always occurs in relation to Sten- 
son 's duct. If the buccal portion is involved, the duct may be 
slit up from within the mouth. If the masseteric portion 
is wounded, a fine probe should be passed into the duct (from 
the mouth) as far as the fistulous opening, and then brought out 
at this orifice. A double thread of silk is now tied to the 
end of the probe and drawn through the thickness of the 
cheek, along the buccal portion of the duct, and out of the 
external wound. A fine drainage tube is then carried along 
the same tract, and left to project both externally and in- 
ternally. A silk thread is attached to each end of the tube 
and knotted around the angle of the mouth. In this manner 
a passage is re-established into the mouth, and as soon as 
it becomes easier for the saliva to travel along this than 
through the external wound, the fistula will close. The outer 
half of the tube may be removed in a few days, and only a 
thread allowed to remain in the external wound, which gradu- 
ally contracts so that more and more of the saliva, finds its way 
to the mouth. The silk thread and tube are finally removed, 
and, if the canal remains patent, the external wound soon heals. 
If the buccal portion of duct is obliterated so that the probe 
cannot be introduced, the thread and tube may be passed 
through all of the tissues of the cheek by means of a trocar 
and canula. The subsequent steps are similar to those of the 
previous method. 

How should hemorrhage from the gums be treated? 

By means of hot water, cold, compression, peroxide of hydro- 
gen, styptics, suprarenal extract, or the actual cautery. If 
due to scurvy, appropriate antiscorbutic treatment ; if due to 
hemophilia, calcium chloride gr. xxx t, i. d. and apply fibrin 
ferment, suprarenal extract, or cocaine, locally. 



ORAL SURGERY. 143 

Define necrosis. Give its diagnosis and treatment. 

By necrosis is meant the death of bone en masse. 

The diagnosis is made by the presence of a sinus, the history 
of a preceding inflammation, and the results obtained by prob- 
ing. Dead bone feels rough and hard ; the probing is not 
painful nor is it followed by bleeding. 

Treatment. — Early in necrosis, endeavor to moderate in- 
flammation upon which the affection depends and open any 
abscesses that may form. During the time occupied by the 
loosening of the dead bone, no operative treatment should be 
instituted, as a rule, but attention should be given to the 
general health. As soon as the necrosed portion has become 
detached, it should be removed. 

What is a dislocation? Name the varieties, and give 
the causes. 

A dislocation is a displacement of one or more bones of a 
joint from its natural position. It is also the displacement 
of any organ from its natural position. 

Traumatic. — Due to violence or muscular action. 

Pathologic. — Due to disease. 

Congenital. — Due to an error of development as a result 
of which a normal location of the bony constituents has never 
been present. (The term congenital "dislocation" is really 
a misnomer — it is a congenital malformation.) 

What is an incised wound? Give the prognosis and 
treatment. 

An incised wound is one made by any sharp cutting instru- 
ment. 

Prognosis. — Nearly always favorable, but depends upon the 
region involved and asepsis of the wound. 

Treatment. — Arrest hemorrhage. Render the wound as 
aseptic as possible. Unite the edges of the wound by means 
of sutures and apply a septic dressing. 

Give diagnosis and treatment of caries. 

The symptoms of caries are those of osteitis complicated by 



144 ORAL SURGERY. 

an abscess leading to the softened bone. When caries is prim- 
ary, it particularly involves the cancellous tissue (ends of 
long bones, flat bones). The pus from carious bone contains 
an excess of phosphate of lime. 

Treatment. — If syphilitic, give potassium iodide; if tuber- 
cular, cod-liver oil with iodide of iron. Secure best hygienic 
surroundings. In early stages while the disease is advancing, 
keep the parts clean and free from irritation. When acute 
symptoms have subsided, an attempt may be made to remove 
the diseased bone by applications of iodine or of the mineral 
acids. If the carious bone can be reached from the surface, it 
may be removed with a gouge or with a burr-head drill. If 
the disease is extensive, excision may be required. In some 
cases amputation is necessary to prevent fatal exhaustion. 

How may general infection be caused by oral operations? 

The wound in the buccal cavity may become infected by any 
of the micro-organisms found within the mouth. From this 
local source, the bacteria, their products, or both, may pass 
into the general circulation. 

Give the symptoms and treatment of acute suppurative 
periostitis. 

If the bone is superficial, there will be all of the symptoms 
and signs of inflammation. If the bone is deep, redness, 
swelling, and heat may not be observed over the inflamed area, 
on account of the density of the periosteum. The pain is of 
a most intense, aching character, worse at night, and greatly 
increased by pressure or by a dependent position of the part. 
If swelling is present, it is brawny in character and subse- 
quently becomes red, edematous and softened in the centre. 
If the abscess has opened spontaneously or has been incised, 
bare bone is exposed, the greater portion of which usually 
dies. This dead bone is either absorbed (if very small in 
amount) or cast off as a sequestrum. 

Treatment. — A free aseptic incision down to the bone at the 
earliest possible moment, Antiseptic dressing. If necrosis 



ORAL SURGERY. 145 

has occurred, it must receive appropriate treatment. Sup- 
porting or antidiabetic treatment constitutionally. 

Give the differential diagnosis between syphilitic and 
aphthous ulceration. 

Syphilitic ulcers occur in the shape of cracks or fissures 
upon the sides or tip of the tongue, or upon the cheeks and 
lips. They are common in the secondary period of the disease. 
Papular eruptions of the skin and mucous patches may also 
be observed. These ulcers respond to anti-syphilitic treatment. 

Aphthae commence as small blisters, which run a rapid 
course and are accompanied by slight salivation. The ulcers 
are superficial, sharply outlined, multiple, and are situated 
not only upon the tongue, but particularly upon the cheeks 
and lips. 

Give the etiology and symptoms of the congenital mal = 
formation known as cleft palate. 

Etiology. — Failure of the palatal processes to unite. 

Symptoms. — Inspection reveals a cleft in the' median line. 
If the palatal process of one side has united with the ethmo- 
vomerine septum, a cleft slightly to one side (usually to the 
left) of the median line is observed. Since the union of the 
palatal processes takes place from before backward, it is rare 
to have a cleft of the anterior portion of the palate without 
the posterior portion being also involved. As a rule, there 
is considerable impairment of nutrition, from interference 
with deglutition. The exposure of the nasal mucous mem- 
brane leads to the formation of scabs which undergo putrefac- 
tive changes, producing a condition somewhat resembling 
ozaena. When the child learns to talk, articulation is fre- 
quently so indistinct that it is difficult to understand, and 
the voice has a peculiar and characteristic intonation. The 
so-called explosives (whether dentals, labials, or gutturals) 
which require a certain amount of air-pressure within the 
mouth for their proper pronunciation, are difficult to pro- 
duce. This is particularly to be observed in the letters 
b, d, p, t, g and f. 
10 



146 ORAL SURGERY. 

Give the diagnosis and treatment of trismus caused by 
impacted third molar. 

Diagnosis. — There is a partial or complete inability to open 
the jaws. Inspection reveals the impaction of the third 
molar. Necrosis may be present. 

Treatment. — Relief of the impaction, either by extraction 
of the offending tooth or of the second molar. If necrosis 
is present, it must be treated upon general principles. 

Mention the most reliable agent for the destruction of 
microorganisms. How should it be used? 

Heat. — It may be used in the form of dry heat or moist heat 
(steam, under pressure if necessary, hot water). It should 
penetrate to the centre of the material to be sterilized. 

What diseases of the tongue may be caused by diseased 
teeth? 

Traumatic ulceration, glossitis, abscess, and epithelioma. 

Describe the preparation of the oral cavity for an 
aseptic operation. 

Asepsis, as applied to the oral cavity, is but a relative term. 
All cavities in the teeth should be cleansed, disinfected and 
filled. The interstices between the teeth must be carefully 
cleansed and the mouth repeatedly washed out by a boric acid 
solution as hot as can be borne. The nasal cavity should also 
be rendered as aseptic as possible, and the patient should 
gargle repeatedly with hot boric acid solutions. 

Define a multilocular cyst. 

A multilocular cyst is one which is composed of a number 
of loculi or chambers. 

Describe treatment and appliance for acquired cleft 
palate. 

Acquired perforations of the palate are usually due to 
syphilis, but lupus and traumatism are also occasional causes. 
Treatment should first be directed to the underlying cause. 
When inflammatory symptoms have subsided and nature has 



ORAL SURGERY. 147 

done all she can to repair the defect, the local treatment is in- 
dicated. If the perforation is small, an attempt may be made 
to close it by freshening the edges of the perforation, dissect- 
ing np muco-periosteal flaps and suturing them together. 
This will rarely be practicable, however, and in the great ma- 
jority of cases an obturator or an artificial velum must be 
introduced. 

An obturator is a plate which is so adjusted as to close the 
perforation. It should never be made in the form of a plug, 
since the opening may be enlarged by the constant pressure 
and irritation. It is made of thin vulcanite or gold, and is 
fixed to the teeth and held in position by suction. Intra- 
nasal projection will sometimes improve the quality of the 
articulation by diminishing the size of the nasal cavity. 

An artificial velum is a plate obturator, to the posterior 
portion of which a hinged segment is attached, to take the 
place of the normal velum. This hinged segment may rest 
upon the nasal side of the soft palate. A thin rubber bag, 
filled with air and sewn to the posterior portion of the 
obturator, is sometimes used in place of the hinged segment. 
Artificial vela are by no means so satisfactory, as a rule, as 
are the plate obturators. 

Define odontalgia. Give the etiology and treatment of 
odontalgia. 

Toothache. 

It may be caused by many different pathologic conditions 
of the tooth or surrounding tissues, such as congestion of the 
pulp, exostosis of the roots, pulp nodules, mechanical or 
chemical irritation, reflected pains from irritation of areas 
supplied by other branches of the fifth nerve (impacted body 
in external auditory meatus, etc.), infection, mal-occlusion, 
exposure of dentine and denudation of roots. 

Treatment. — Removal of the cause. In the majority of 
cases the pulp of the tooth must be removed. Tincture of 
iodine to the gums and chloroform or oil of cloves to cavities 
in teeth, might be mentioned as temporary measures. 



148 ORAL SURGERY. 

Describe (a) Sylvester's method of producing artificial 
respiration; (b) Laborde's method of producing artificial 
respiration. 

(a) Sylvester's method. — The patient is placed upon his 
back with a folded coat or a pillow beneath the interscapular 
region, the throat is cleared of mucus, the tongue held well for- 
ward, and all constricting clothing removed from throat and 
abdomen. The operator kneels or stands behind the patient. 
The forearms are grasped near the fully flexed elbows and 
the lower portion of the thorax is compressed for a few 
seconds by forcing the patient's elbows against the thoracic 
wall. The arms are then moved outwards and upwards until 
the hands cross over the head. This secures elevation of the 
costal walls and simulates inspiration. The arms are kept 
in this position for a few seconds and then brought down- 
ward to the first position, pressure being made upon the 
costal walls with the elbows of the patient. This simulates 
expiration. These movements are to be repeated from twelve 
to fifteen times a minute. 

(t) Laborde's method. — After clearing the throat of mucus, 
rhythmic traction is made upon the tongue. 

Describe the effect of arsenic upon the pulp of a tooth. 

The pulp becomes devitalized and there is an absence of 
the previously existing sensibility, as may be demonstrated 
by the use of any exploring instrument. 

State the pathologic changes in chronic inflammation. 

Dilatation of blood vessels, slowing of current, exudation of 
fluid, transmigration of leucocytes and multiplication of the 
pre-existing connective tissue cells of the part. The only dif- 
ference between acute and chronic inflammation is one of 
degree. In chronic inflammation the productive changes are 
much more marked than the exudative or the degenera- 
tive ones. 

Describe the healing of wounds, irrespective of the ana= 
tomic structure of the tissue involved. 

The healing of an aseptic wound will be described. There 



ORAL SURGERY. 149 

is a certain amount of exudation, resulting in the formation 
of fibrin, which temporarily binds the lips of the wound to- 
gether. This network of fibrin serves as a framework for the 
leucocytes and multiplied connective tissue cells. The exu- 
date becomes vascularized and is then known as granulation 
tissue. The leucocytes have nothing to do with the building 
up of tissue. They destroy the fibrin network and then either 
return to the circulation or are fed upon by the connective 
tissue cells or fibroblasts. The fibroblasts soon become spindle- 
shaped, and their ends become split up into primitive fibrillar 
This conversion of the round fibroblasts into the connective 
tissue fibre results in the contraction of the cicatrix, which 
binds the lips of the wound tightly together. 

Define contusion, luxation and fracture. 

A contusion is a subcutaneous laceration of the tissues. 

A luxation is a displacement, as regards their relative posi- 
tion, of the bones which enter into the formation of a joint. 

A fracture is a solution of continuity of bone, produced by 
violence. 

Name two forms of tumors which may involve the 
tissues of the face or jaws. State whether benign or 
maHgnant and briefly outline surgical treatment. 

Epithelioma, sarcoma. 

Both of these tumors are malignant. 

The treatment consists of the thorough removal of all of the 
affected tissues. If a complete operation cannot be performed, 
the treatment is simply palliative. 

Name three congenital deformities of the oral tissues 
which affect the speech. Briefly outline the surgical 
treatment of each. 

Microglossia, hare-lip, and cleft palate. 

Microglossia is best treated by removing a V-shaped piece 
of the tongue, with the apex directed backward, and uniting 
the resulting wound by sutures. 

Hare-lip is treated by paring the edges of the cleft and 



150 ORAL SURGERY. 

bringing them together by sutures. The depth of the lip 
should be increased to allow for subsequent contraction. 

Cleft palate is treated by paring the margins of the cleft, 
together with its anterior angle, elevating the two lateral flaps 
of mucoperiosteum and uniting them in the median line by 
sutures. Lateral incisions are made if it is necessary to re- 
lieve tension. 

Give the causes of antral empyema. 

The extension of inflammation from carious teeth, direct 
violence applied over the cavity, an injury to the alveolar pro- 
cess which opens the antrum, and the extension of a suppura- 
tive process from the nasal cavity. 

Differentiate between fracture and dislocation of the 
mandibular condyle. 

Tn fracture of the neck of the condyle, the condyloid frag- 
ment is drawn forward and inward by the external pterygoid 
muscle and the body of the bone is displaced toward the oppo- 
site side, somewhat simulating a dislocation. The mouth is 
closed, however, and any attempt to open it produces pain and 
generally crepitus. The deformity recurs almost immediately 
after reduction unless the fragments are held in apposition. 

Tn dislocation of the mandibular condyle (unilateral dis- 
location of the jaw) the mouth is open and cannot be closed. 
The chin is directed toward the sound side. Upon external 
palpation the condyle can be felt in front of its normal posi- 
tion which is the site of a vacuity; upon internal palpation 
the coronoid process may be felt in an advanced position. 
Crepitus is absent and the deformity does not recur after 
reduction as long as the mouth is kept closed. 

a. Describe tic doloreux. b, Why is it of special inter- 
est to the dentist? c. What surgical operations are prac- 
ticed for its relief? 

Tic doloreux or trifacial neuralgia is characterized by severe 
paroxysmal pain in the region supplied by one or more of the 
divisions of the trifacial nerve and is not associated with 
structural changes in the nerve. 



ORAL SURGERY. 151 

b. Tic doloreux is of special interest to the dentist because 
it may simulate affections of the teeth, of the alveolar pro- 
cess, or of the maxillary antrum. 

c. The surgical operations practised for its relief are neurec- 
tomy of the affected branch of the fifth nerve, excision of the 
nerve and plugging the particular canal, removal of Meckel 's 
ganglion, and removal of the Gasserian ganglion. 

Give the diagnosis of ranula. 

A ranula is a cystic swelling in the floor of the mouth gener- 
ally to one side of the median line. It is translucent and 
bluish in appearance and is covered with thin healthy mucous 
membrane. The fluctuating mass may push up the anterior 
portion of the tongue and interfere with deglutition and arti- 
culation. Inflammatory symptoms are absent. Puncture re- 
veals a glairy viscid fluid somewhat resembling saliva. 

A dermoid cyst in this region usually involves the tongue 
to a greater or less degree, is more deeply placed than a ranula, 
and is more apt to project and give fluctuation in the submaxil- 
lary region. 

Differentiate between dislocation and double fracture 
of the lower jaw. 

In bilateral dislocation, the mouth is wide open and cannot 
be closed. Upon both sides, there is a vacuity in front of the 
tragus and the condyle may be palpated in an advanced posi- 
tion ; palpation from within the mouth reveals an anterior dis- 
placement of the coronoid processes. The chin is carried for- 
ward and downward so that face seems to be elongated. 

Double fracture is characterized by loosening and irregular- 
ity of the teeth, preternatural mobility, crepitus, and drib- 
bling of bloody saliva. The central fragment is displaced 
downwards by the suprahyoid muscles. 

Name and describe the surgical operation for cleft palate. 

The operation proposed by Brophy of Chicago promises to 
revolutionize the treatment of cleft palate. 

lie perfers operating at the third month. Observing all 



152 ORAL SURGERY. 

antiseptic detail, the mucous membrane at the margin of the 
cleft is divided and all of the soft tissues are elevated from 
the hard palate, including the periosteum. The edges of the 
cleft are then pared throughout the entire length of the soft 
palate and the membranes at the distal surface of the hori- 
zontal plates of the palate bones are divided. This allows the 
soft parts to fall together and obviates the necessity of mak- 
ing lateral incisions into or through the palate. Four tension 
sutures of silver wire No. 22 are now introduced and their 
extremities are passed through lead plates. These lead plates 
(No. 22 American gauge), are perforated with holes, corres- 
ponding to the number of sutures, and extend from the an- 
terior margin of the fissure to the distal border of the soft 
palate and are moulded to conform to its shape. Before the 
lead plates are fixed in place, coaptation sutures of silk are 
introduced into the margins of the cleft but are not tied until 
the edges of the cleft have been approximated by the tension 
sutures and lead plates. Immediate union should be secured. 
If the patient is older and the bones have commenced to 
harden, Brophy thoroughly removes the edges of the fissure 
and trims the opposing edges of the bones. The cheek is 
then raised and a strong special needle threaded with a large 
braided silk ligature, is passed through the substance of the 
bone to the central fissure. The needle is introduced just back 
of the malar process and high enough to insure its passage 
above the palate bone. An opposite needle now carries a 
corresponding suture through the opposite side, one loop is 
threaded into the other, and one loop may thus be carried 
through both maxillary bones. Silver wire No. 20 is now 
threaded into the loop of silk and drawn through both bones. 
In a similar manner a second wire suture is passed nearer the 
anterior portion of the maxilla above the palatal plate. Two 
lead plates (No. 17 American gauge) are now made to fit the 
buccal convexity of the bone and are perforated for the re- 
ception of the silver sutures. Upon each side the posterior 
suture is twisted with the anterior suture until the bones 
are approximated. If the bones do not come together a hori- 



ORAL SURGERY. 153 

zontal section of the malar process is made upon each side 
when the bone can be readily moved toward the median line. 
Any irregularities of the cleft may be closed by a few coapta- 
tion sutures of silk, but this is not usually necessary. 

a. How is a simple cyst in soft tissues differentiated from 
other tumors? b. What surgical measures are necessary 
to prevent its recurrence? c. Are cystic growths classi= 
tied as benign or malignant? 

a. A cyst is characterized by an absence of inflammatory 
symptoms, unless it is inflamed. Fluctuation is present and 
the hypodermatic needle reveals a non-purulent fluid. A 
superficial cyst can be better outlined than is the case with 
an abscess. 

b. The complete removal of the cyst wall. 

c. Cystic growths are classified as benign. 

a. Give diagnosis of necrotic alveolar process, b. What 
important condition of the diseased bone should be deter= 
mined before operating? c. Outline the operation. 

a. There will usually be one or more sinuses which lead 
down to sequestra. Necrosed bone can be readily recognized 
by the hard and rough sensation communicated by the probe. 

b. No operation should be performed until the sequestrum 
has become detached. 

c. Make an incision down to the bone in the line of the prin- 
cipal cloacae. Two or more of these are united by sawing 
through the invaginating bony tissue with a Hey's or Gigli 
saw and the sequestrum is freely exposed. The sequestrum 
may now be withdrawn entire, or, if necessary, sawn in two 
and each half extracted separately. The cavity should be 
thoroughly irrigated and packed with antiseptic gauze. 

a. In a case of accidental obstruction of the glottis with 
strangulation and death impending, what should be done 
to save the life of the patient? b. Give details of procedure. 

a. Tracheotomy. 

b. The patient is placed in the dorsal position with the 



154 ORAL SURGERY. 

head extended and held in such a position that the median 
line of the face will correspond to the median line of the 
neck. An incision, about two inches in length is made in the 
median line, from below upward, and terminating at the thy- 
roid cartilage. This incision divides the skin and superficial 
fascia. The anterior jugular veins, lying to either side of 
the median line, should be avoided by cutting between them 
and drawing them aside. The deep cervical fascia is next 
divided, the interval between the pretracheal muscles re- 
cognized, and the wound deepened by blunt dissection. The 
pretracheal fascia is now divided and the isthmus of the 
thyroid gland drawn downward. After hemorrhage has been 
checked and the tracheal rings exposed, the trachea is steadied 
(by a tenaculum if possible) and two or three rings are 
divided from below upward. The edges of the tracheal 
wound are then held apart. The wound and surrounding 
area should now be rendered as aseptic as possible, a suitable 
tracheotomy tube procured and inserted, and an antiseptic 
dressing applied. 

What facial and ora! tissues are usually attacked by 
epithelioma? 

The lip and the tongue are the parts most commonly af- 
fected but any portion of the epithelial surface (such as the 
gums or the buccal parieties) may be attacked. 

How may a foreign body be removed from the posterior 
nasal passages when lodged beyond the reach of tweezers 
or forceps? Example — a grain of corn, bead, or button. 

The foreign body can generally be pushed down into the 
pharynx by a probe introduced into the anterior nares. Care 
should be taken that it is not inhaled into the larynx or 
trachea or swallowed. 

In some cases it may be possible to dislodge it by the use 
of the Politzer bag or by syringing. Sajou's method may be 
tried, — it consists of drawing a cotton or wool tampon through 
the nasal passage from behind. It may be necessary to first 
break up the foreign body by drilling. 



ORAL SURGERY. 155 

What is the treatment for the relief of empyema of the 
antrum when the teeth are sound and in place? 

The establishment of efficient drainage and thorough irri- 
gation of the cavity of the antrum. A sufficiently large open- 
ing should be made in the anterior wall of the antrum in the 
region of the canine fossa. The cause of the disease should 
also receive appropriate treatment. 

Give the etiology and characteristics of suppurative in= 
flarnmation. 

From a clinical standpoint all suppurative inflammations 
are due to the presence of pyogenic bacteria which may gain 
access to the affected part, through a wound or through the 
circulation. 

When an inflammation terminates in suppuration, the pain 
is at first dull and aching, and then assumes a throbbing 
character. The hard and brawny swelling becomes soft and 
fluctuating in the center and the overlying skin is edematous. 
The swelling also becomes more localized than in simple in- 
flammation and the redness assumes a dusky hue. The con- 
stitutional symptoms of impending suppuration are the oc- 
currence of a rigor or merely a sensation of chilliness, sweat- 
ing, and a sharp rise of temperature. 

Describe the intermittent pu!se, the thready pulse, and 
the hard pulse. 

An intermittent pulse is one in which a beat is occassionally 
missing while the pulse, in the intervals, is perfectly regular. 

The thready pulse is one of low tension and the artery can 
be palpated only during the beat. 

The hard pulse is one of high tension and the artery is 
full between the beats and can be rolled beneath the finger. 

Mention the disinfecting lotions used for surgical ir= 
rigations. 

Solution of bichloride of mercury (1-4000) and of car- 
bolic acid (1-100) are the ones usually employed. Mention 
might be made of lysol, creolin, salicylic acid, boric acid, hy- 



156 ORAL SURGERY. 

drogen peroxide, potassium permanganate, oxalic acid, and 
chlorin water. 

State what the elevation of the body temperature dur= 
ing the treatment of fractures of the maxillae indicates. 
Give treatment. 

If the rise of temperature is not marked it is simply a con- 
comitant of the healing process and requires no special treat- 
ment. If the fracture is compound the most rigid asepsis 
possible should be observed. 

A considerable rise of temperature accompanied by a rigor 
or a chilly sensation and throbbing pain indicates the forma- 
tion of pus. The treatment would naturally consist in the 
evacuation of the pus, free drainage and the maintenance of 
the parts in as aseptic a condition as possible. 

Give the etiology, pathology, and treatment of chronic 
alveolar abscess. 

Practically all cases of alveolar abscess are due to carious 
teeth. 

The pathology is that of any chronic abscess in bone. First 
we have an osteitis and the inflammatory exudate, instead of 
becoming vascularized and converted into new tissue, breaks 
down ; its cells perish from malnutrition, degeneration occurs, 
and suppuration is the result. 

While the abscess may be reached through the alveolus, the 
best method is to extract the tooth, thus removing the original 
cause and securing drainage. In obstinate cases the abscess 
cavity should be curetted and packed with iodoform gauze. If 
a fragment of necrosed bone is present it must be removed to 
secure closure of the sinus. 

State the method of arresting hemorrhage from the in- 
ferior dental canal. 

By plugging the bleeding point with Halsted's "gut wool/' 
or with Horsley's antiseptic wax (beeswax seven parts, al- 
mond oil one part, and salicylic acid one part) . 



ORAL SURGERY. 157 

Give the etiology, diagnosis, and prognosis of carcinoma 
of the mucous membrane of the buccal cavity. 

The etiology of carcinoma of the buccal mucous membrane 
is as obscure as is that of carcinoma in general. A predis- 
posing cause may be furnished by continual irritation such 
as the edge of a carious tooth or the taking of hot foods or 
undiluted spirits. 

The affection may commence as an ulcer or fissure, as a 
papilloma, or as a nodule, but in nearly all cases it is char- 
acterized by the early occurrence of ulceration and the ulcer- 
ated surface is surrounded by an indurated everted margin. 
Pain is not present early in the disease but may prove a valu- 
able factor in the diagnosis. The neighboring lymphatic 
glands may be involved. The age of the patient will usually 
furnish an additional aid. 

The prognosis is guardedly favorable if the growth can be 
entirely removed. If a complete operation is impossible the 
prognosis is absolutely unfavorable. 

Mention the rules necessary for surgical cleanliness. 

The entire field of operation, and the hands of the oper- 
ator should be rendered as aseptic as possible. 

The instruments, sponges, sutures, ligatures and everything 
coming in contact with the wound should be sterile. 

Free drainage should be provided if much exudation is ex- 
pected in the wound. 

After the operation the wound should be kept as aseptic as 
possible either by sterile occlusive dressings or by irrigation 
with antiseptic solutions according to the exigencies of the 
case. 

Describe (a) a quick pulse; (b) a feeble pulse; (c) an 
irregular pulse. State what each indicates. 

(a) The term "quick pulse' 1 is ambiguous. According to 
Broadbent, the word quick is capable of two applications in 
this connection since it may apply either to the rate at which 
the beats follow each other or to the character of the in- 
dividual beats. A "quick pulse" may consequently mean 



158 ORAL SURGERY. 

either a frequent pulse or one in which the individual pulsa- 
tions are of short duration. A frequent pulse may be due to 
septic infection. A pulse in which the individual beats are of 
short duration is due to diminished intravascular tension. 

(6) A feeble pulse is one that is weaker than normal and 
usually indicates cardiac insufficiency. 

(c) An irregular pulse is one in which the beats follow each 
other at irregular intervals and are unequal in force. If of 
occasional occurrence it indicates reflex disturbance of the 
cardiac rhythm, gastric derangement with or without flatu- 
lence, or other functional affections. If permanent in char- 
acter it may indicate cardiac disease, affections of the re- 
spiratory organs, or the abuse of tobacco, tea, &c. 

Describe the operation of removing a benign tumor. 

A lipoma of the back will be selected as an example. After 
all aseptic precautions have been observed, an incision is made 
over the tumor extending down to its capsule. The fatty 
tumor and its capsule are then enucleated, usually by blunt 
dissection, all hemorrhage checked, the edges of the wound 
are united by sutures, and an aseptic dressing is applied. 

Describe the operation of removing a malignant tumor. 

We operate just as in the case of the benign growth but 
the incisions must be carried wide of the tumor and well into 
the surrounding healthy tissue. If neighboring lymphatic 
glands are involved they must be removed in continuity with 
the growth and no incision is to be made across the interven- 
ing lymphatic channels. The primary object is the complete 
removal of the tumor and the closure of the wound is of 
secondary importance. If a great deal of skin must be sacri- 
ficed the wound may be closed by sliding one or more flaps 
over it or by skin grafting. A rigid aseptic technique should 
be observed. 

dive the etiology, clinical appearance, and treatment of 
smoker's patch of the tongue. 

Smoker's patch is the stage of chronic superficial glossitis 
which is known as leukoplakia. It is due to an inflammation 



ORAL SURGERY. 159 

of the mucous membrane causing an overgrowth of epithelium, 
which becomes heaped up into rough, dry, horny patches. 
The inflammation may be caused by excessive smoking, the 
drinking of undiluted spirits, the ingestion of highly seasoned 
foods, syphilis, or a combination of several of these causes. 

The treatment is unsatisfactory as far as cure is concerned. 
The exciting factor should be removed and the patch carefully 
watched for signs of commencing malignancy. The diet should 
be bland, sterile, and unirritating, and, after each meal, 
the teeth should be brushed and the mouth rinsed out with 
some mild antiseptic solution. No local applications should 
be made. Appropriate constitutional treatment should be 
instituted in syphilitic cases. 

Differentiate shock and syncope. 

Shock may be denned as the immediate constitutional ef- 
fect of an injury. "It is that state of general depression of 
the vital activity which occurs after severe injuries, especially 
where there has been violent stimulation of the peripheral 
nerves and nerve-endings, but may be induced also by some 
powerful impression applied to nerve centres" (Pick). 

Syncope is a state of suspended animation, due to sudden 
failure of the heart's action, producing anemia of the brain. 
It may occur without injury and be produced by the emotions, 
intrinsic cardiac conditions, depression of the heart from 
hunger or exhaustion, or by a sudden loss of blood. 

Differentiate carcinoma of the tongue and gummatous 
ulcer of the tongue. 

Carcinoma. Gummatous ulcer. 

Always single. May be multiple. 

Usually in the anterior half and Chiefly far back on the dorsum, 
at the side of the tongue. Other syphilitic lesions may be 

present in the mouth. 

Lymphatic glands usually involved. Lymphatic glands rarely involved. 

Painful. Painless. 



160 ORAL SURGERY. 

Induration follows ulceration. Induration precedes ulceration. 

Everted ragged edges. Sharp-cut edges. 

There may be a history of preced- History of preceding syphilis, 
ing chronic superficial glossitis. 

Patient usually past 40. May be younger. 

Does not improve on potassium Improves rapidly on potassium 
iodide. iodide. 

The microscope may determine the diagnosis in doubtful 
cases. Both carcinoma and gumma are much more frequent 
in males than females (5 to 1). 

Describe the symptoms of syncope that may occur during 
the administration of chloroform. Give treatment. 

Sudden cessation of the pulse, sudden dilation of the pupil, 
blanching of the face, and secondary failure of respiration. 

Treatment. Stop the anesthetic. Invert the patient. An 
assistant should administer a hypodermatic injection of ether 
followed by one of strychnine and the operator should com- 
mence artificial respiration as soon as possible, care being 
taken that the tongue is held well forward to allow the air 
to enter the lungs. 

Give the etiology, diagnosis, and treatment of ulcer. 

The causes of ulceration are either constitutional or local. 

The constitutional causes all act by producing an impair- 
ment of vitality. These causes are senility, deficient innerva- 
tion, and diseases which induce malnutrition such as scurvy, 
diabetes, tuberculosis, and syphilis. 

The local causes are either interference with the circula- 
tion of a part or some irritation applied to a part. 

Diagnosis. An ulcer is a solution of continuity of the skin 
or mucous membrane due to molecular or particulate death 
of the part. 

Treatment. The constitutional treatment is that of the 
underlying disease or condition of malnutrition. It may be 



ORAL SURGERY. 161 

said in general that the local treatment consists of the re- 
moval of the cause and the maintenance of the ulcer in as 
aseptic a condition as possible; it will naturally vary with 
the particular variety of ulcer. 

Describe (a) a frequent pulse; (b) a soft puSse. State 
what each indicates. 

(a) A frequent pulse is one which beats more rapidly than 
that of the average healthy individual. It may be due to 
idiosyncrasy, the action of drugs, or almost any departure 
from a normal state of health. 

(&) A soft pulse is one in which there is no increase of the 
intravascular tension. It may be felt in health. 

Give the etiology and treatment of acute infectious 
osteomyelitis of the inferior maxilla. 

Acute infectious osteomyelitis of the inferior maxilla may 
result from infection from without (as in a compound frac- 
ture) or from infection from within (hematogenous infec- 
tion). Various micro-organisms may be responsible, such 
as staphylococci, streptococci, typhoid bacilli, and the bacillus 
coli communis. 

The treatment should be early and energetic. It consists 
of making a large opening in the mandible and scraping out 
all of the diseased marrow. The medullary cavity should 
then be irrigated by strong solutions of bichloride of mercury 
(1-1000) and packed with iodoform gauze. 

State the complication that may arise from a compound 
fracture of the inferior maxilla. Give treatment. 

Acute infectious osteomyelitis. See answer to preceding 
question. 

Give the etiology, the pathologic anatomy, the constitu- 
tional symptoms, and the treatment of necrosis of the 
maxilla. 

Necrosis is practically always due to arrested circulation 
in the bone. This may result from injury, as when the 
11 



162 ORAL SURGERY. 

periosteum is torn away in a compound fracture. In ostitis 
the vessels may be compressed by the exudate in the Haversian 
canals and in acute periostitis and osteomyelitis the nutritive 
supply may be entirely destroyed and extensive necrosis re- 
sult. Necrosis of the jaw may also occur from exposure to 
the fumes of phosphorus or as the result of mercury when 
given to excess. 

Pathologic Anatomy. Where the necrosis is due to injury 
and only the outer laminae perish we speak of peripheral ne- 
crosis. If there is a limited inflammation of the cancellous 
tissue, usually tubercular, which leads to the death of a por- 
tion of the bone, as in chronic abscess, we speak of central 
necrosis. 

If the entire thickness of the bone is destroyed, as in cases 
of panosteitis, the term total necrosis is applied. 

The portion of dead bone is called a sequestrum. The peri- 
osteum surrounding a sequestrum deposits new bone and so 
forms an involucrum or invaginating sheath about the dead 
tissue. In this involucrum are a number of openings or cloacae 
which allow the pus to escape externally through sinuses in the 
soft parts. Where the periosteum has been torn away, re- 
sulting in peripheral necrosis, an invaginating sheath is not 
formed but the sequestrum is cast off by exfoliation. 

The constitutional symptoms vary according to the amount 
of tissue involved and the nature of the infection. If the ne- 
crosis is peripheral the only constitutional symptom may be 
a slight rise of temperature; but if it be total, as in cases of 
acute osteomyelitis, the patient is violently ill, and chills, 
hyperpyrexia, and profuse sweating are observed. 

The treatment consists of the removal of the sequestrum as 
soon as it has become loosened, the disinfection of the remain- 
ing cavity, and tamponade with iodoform gauze maintaining 
the parts in as aseptic a condition as possible and supporting 
the general health by appropriate measures. In cases of 
acute osteomyelitis, we do not wait for the sequestrum to form 
but clean out the medullary cavity at once as previously de- 
scribed. ■ i 



ORAL SURGERY. 163 

Give the etiology, the pathologic anatomy, and the 
microscopic appearance of acute local periostitis. 

Acute local periostitis is usually the result of injury but 
may also be due to extension of an inflammation from the 
surrounding parts (example periostitis of the jaw from alveo- 
lar abscess). It may also result from constitutional diseases 
such as tuberculosis or syphilis and may follow acute rheu- 
matism, typhoid fever, scarlet fever, or measles. 

Pathologic Anatomy. The periosteum is swollen and red; 
its deeper layers in particular are infiltrated by inflammatory 
exudate which accumulate between the periosteum and the 
bone. The swelling produced in this manner is known as a 
periosteal node. 

The microscopic appearance is that of any acute inflam- 
mation. The vessels are distended and tortuous and the 
tissues are infiltrated with small round cells. If the disease 
has lasted some time areas of necrosis may be observed. 

Give the etioSogy and pathologic anatomy of caries of 
the maxillae. 

Caries is usually a tubercular affection but may be due to 
other conditions. It may occur upon the surface of a bone 
beneath a superiosteal gumma. It may also be the result of 
a non-tubercular rarefying ostitis where the entire bony struc- 
ture is absorbed and converted into granulation tissue. 

Pathologic Anatomy. As a result of hyperemia and the 
outpouring of an inflammatory exudate, the Haversian canals 
and trabecular spaces become crowded with granulation tissue 
which may show the characteristic structure of tuberculous 
disease. Some of these cells destroy the walls of the Haver- 
sian canals, forming the so-called Howship's lacunae. The 
cells situated within these lacunae are known as osteoclasts. 
The remainder of the granulation tissue undergoes caseation 
and this form of caries is called caries suppurativa. When 
the granulation tissue destroys the bone and then becomes 
absorbed, instead of undergoing caseation, we speak of caries 
sicca. If the granulation tissue is excessive and the destruc- 



164 ORAL SURGERY. 

tion of bone is rapid so that it fungates into a joint or be- 
neath the skin, the name of caries fungosa. is applied. In 
some instances the granulation tissue dies before it absorbs and 
replaces the bone. In such a case, a mass of bone may be cut 
off from its nutritive vessels and die en masse when we speak 
of caries necrotica. 

Describe the character of the pain in trifacial neuralgia. 
State the location of pain when each of the three divisions 
is affected. 

The pain of trifacial neuralgia is paroxysmal and may be 
burning, darting, or lancinating in character. The skin may 
be exquisitely tender, particularly at certain points along 
the course of the nerve, the so-called tender points. The pain 
may sometimes be preceded by a tingling sensation and is 
usually limited to a certain group of nerves upon one side 
of the face. It may sometimes be relieved by pressure. . 

"When the ophthalmic division is affected the pain is located 
in the forehead, orbit, and nose. 

W 7 hen the superior maxillary division is affected the pain is 
located in the lower lid, in the side of the nose, in the lip, in 
the upper jaw, in the roof of the mouth, and in the upper 
teeth. 

WQien the inferior maxillary division is affected the pain 
is located in the ear, in the temporal region, in the lower jaw, 
and in the lower teeth. 

Give the symptoms and treatment of syphilitic perio- 
stitis. State the pathologic changes that may occur in 
syphilitic periostitis. 

In the early stages of secondary syphilis there may be ach- 
ing pains in the superficial bones and their surfaces may ex- 
hibit swellings which are very tender to the touch. The tem- 
perature of the patient is slightly increased. This form of 
periostitis soon disappears under the administration of mer- 
cury to which it is well to add some iodide of potassium which 
generally relieves the pain immediately. 

In the later stages of secondary syphilis a single periosteal 



ORAL SURGERY. 165 

node may appear upon one of the superficial bones. It is ac- 
companied by aching pain which is always worse when the 
patient is warm in bed. The treatment consists of the ad- 
ministration of iodide of potassium. 

The pathologic changes that may occur in syphilitic peri- 
ostitis are caries, necrosis, the formation of gummata, and the 
formation of new bone. 

Give the etiology and symptoms of salivary calculus. 

Mixed saliva contains a certain percentage of calcium salts 
which are held in solution by carbon dioxid. Lactic acid fer- 
mentation is so common in the human mouth as to be almost 
a characteristic. This lactic acid coagulates the mucin; the 
calcium salts are precipitated by the escape of their solvent, 
carbon dioxide, and become entangled in the mucin coagulum. 
It is stated that coagulation of the mucin is not necessary to 
bring about this condition of affairs but that it's inspissation 
is alone sufficient. 

Symptom. The calculi are found upon the surfaces of the 
teeth, particularly opposite the mouths of salivary glands; 
beneath the margins of the gums, and in the ducts of the 
muciparous salivary glands (sublingual and submaxillary). 
The symptoms in general are those of a persistent foreign body 
in contact with a vital tissue. 

Give the etiology, pathology and treatment of acute 
alveolar abscess. 

Acute alveolar abscess is practically always the result of 
decayed teeth. 

The most superficial variety is known as ' ' gum-boil. ' ' The 
deeper varieties commence at the apex of a decayed fang. 
The pus may perforate the alveolar wall (or pass over its 
edge) and form a localized collection beneath the periosteum 
which may ultimately lead to necrosis of the jaw. 

In the upper jaw, the affection may cause empyema of the 
maxillary sinus or burrow along the hard palate; in the 
lower jaw, it may point on the cheek or at the lower margin 
of the bone. 



166 ORAL SURGERY. 

The treatment consists of removing the offending tooth and 
establishing free drainage. In some cases drainage may be 
secured by drilling through the alveolar process but it is not 
a satisfactory method in general, owing to the difficulty of 
locating the particular fang involved. In the very super- 
ficial forms of acute alveolar abscess the tooth may be saved. 

Give the etiology of acute arthritis. 

Acute arthritis may begin in the synovial membrane as a 
rheumatic synovitis, as a septic synovitis (from the intro- 
duction of septic material from without through a wound), 
or as an infective synovitis (from the introduction of organ- 
isms from within through the blood) . It may also result 
from disease of the contiguous soft parts (as in suppurative 
bursitis, phlegmonous erysipelas) or from disease of the 
neighboring bones (as in the acute arthritis of infants). 

Give the treatment of aseptic wounds. 

Rest and the maintenance of asepsis by a sterile occlusive 
dressing. 

State the causes of irregularities of the teeth. 

Early extraction of deciduous teeth, delayed loss of de- 
ciduous teeth, early extraction of permanent first molar, and 
cleft palate. 

Give the etiology and clinical appearance of salivary 
fistula. 

Salivary fistula may be due to a wound of the cheek divid- 
ing Stenson's duct; the saliva escapes through the opening 
and prevents closure of the external wound. It may also 
result from an abscess of the duct caused by an impacted 
salivary calculus. 

Clinical Appearance. There is a fistulous opening in the 
cheek which is generally surrounded by a number of small 
granulations. Saliva flows through the fistula as soon as 
the patient commences to eat and produces excoriation of the 
surrounding skin. 



ORAL SURGERY. 167 

Give the etiology, diagnosis, prognosis, and treatment of 
chronic traumatic ulcers of the tongue. 

Chronic traumatic ulcers of the tongue are due to irrita- 
tion from a jagged tooth, a mass of tartar, or the edge of a 
plate. 

The diagnosis is made by the discovery of the exciting cause 
and the exclusion of the other varieties of ulceration. These 
ulcers are usually situated at the side of the tongue opposite 
the offending tooth ; they are ragged and irregular. 

If the ulcer has been present for a long time, slight indura- 
tion may be observed. The glands are not enlarged. The 
diagnosis is confirmed by the healing of the ulcer after the re- 
moval of the local irritation. 

The prognosis is favorable. 

The treatment consists of the removal of the cause and the 
maintenance of the oral cavity in as aseptic a condition as 
possible. 

State how the different forms of heat may be applied in 
the treatment of inflammation. How does heat affect the 
white blood corpuscles? 

Dry heat may be applied by an india-rubber bag containing 
hot water ; by a rubber tube or a Leiter 's tube through which 
flows a stream of hot water ; or by the application of a flannel 
bag containing hot salt. 

Moist heat is applied by poultices or fomentations. 

The ameboid movements of the white blood corpuscles of 
mammalian blood are increased by a temperature of 38 de- 
grees C. (100.4 deg. F.). Considerable elevations of tem- 
perature destroy the white blood corpuscles. 

Give the etiology and treatment of cellulitis. 

Cellulitis may be due to infection with the streptococcus 
pyogenes, the bites of snakes, dissecting wounds, and to some 
animal poisons (as those of fetid urine extravasated into the 
tissues in cases of ruptured urethra.) 

The treatment consists of early and free incisions to afford 
a. ready exit for the effused products of inflammation. 



168 ORAL SURGERY. 

Warmth and moisture should be applied in the shape of anti- 
septic fomentations and the part should be kept at rest. Tho 
constitutional treatment should be supporting in character. 
The diet should be liquid and nourishing. 

Give the etiology and treatment of primary swelling 
in inflammation. 

The swelling in inflammation is due to the engorgement of 
the blood vessels, to the exudation of the watery elements of 
the blood, and to the transmigration of leucocytes. In the 
so-called third stage of inflammation, this swelling is in- 
creased by the multiplication of the pre-existing connective 
tissut cells of the part. 

The treatment consists of rest, position the application of 
heat or cold, local depletion and the other measures previ- 
ously mentioned under the treatment of inflammation in 
general. 

State the effect of local bleeding upon inflamed tissues. 

Local bleeding depletes the inflammatory area and conse- 
quently diminishes the amount of exudate by decreasing the 
intravascular tension. 

When does secondary hemorrhage occur? Give the 
treatment of secondary hemorrhage. 

At a later period than twenty-four hours after the accident 
or operation. 

Preventive Treatment. Thorough asepsis, the proper ap- 
plication of ligatures to all bleeding points, and the avoidance 
of the injudicious use of stimulants. 

Curative Treatment. This will depend upon whether the 
hemorrhage comes from the end of a divided artery (as in a 
stump) or whether it comes from an artery that has been 
ligated in its continuity. Much might be written under this 
head from a surgical standpoint; but as far as dentistry is 
concerned it suffices to say, in a general way, that the treat- 
ment consists in securing the blood vessels by one or more 
ligatures. In mild cases of secondary hemorrhage from the 



ORAL SURGERY. 169 

end of a divided artery, elevation, exposure to air, irrigation 
with hot sterile saline solution, and firm bandaging may be 
sufficient. If ligatures can not be employed on account of 
the septic condition of the tissues, the actual cautery will be 
of service. All septic sloughs should be curetted away, and 
the wound swabbed out with carbolic solution (1-20) or with 
a solution of chloride of zinc (1-12). The wound should then 
be dusted with iodoform crystals, firmly packed with iodo- 
form gauze, and a firm bandage applied. 

State the causes of arrest of development of the maxil= 
lary bones. 

Early extraction of deciduous teeth, early extraction of the 
permanent first molar, ankylosis of the temporo-maxillary 
articulation. 

Describe Angle's method of treating a fractured maxilla 
or mandible. 

Angle 's method of treating a fractured maxilla or mandible 
consists of holding the jaws in fixed contact by means of wire 
ligatures wrapped in the form of the figure 8 around buttons 
attached to bands encircling suitable opposite or nearly oppo- 
site teeth. 

This method is not based upon sound principles. A better 
result can always be obtained by wiring. 

Describe the treatment of a single fracture of an eden=» 
tulous jaw when the patient has an artificial upper and 
lower denture. 

The upper and lower dentures are to be united (by solder- 
ing or vulcanization as the case may be) and used as an inter- 
maxillary splint. The upper and lower central incisors are 
removed to facilitate the feeding of the patient and external 
support is furnished by a Barton bandage. 

If the patient is a fit subject for anesthesia such a fracture 
would be better treated by wiring the fragments together. 



PATHOLOGY. 



What are spores? How may nutrient media be freed 
from spores at a temperature below ioo degrees C? 

Spores are reproductive bodies of lower vegetable organ- 
isms (of bacteria, for example). 

Nutrient media may be freed from spores at a temperature 
below 100° C. by the process of fractional sterilization. The 
nutrient media are exposed to a temperature of 80° C. for 
15 minutes. This destroys the bacteria, and the media are 
then kept at the room temperature for 24 hours so that the 
spores may develop into bacteria. These bacteria are de- 
stroyed by an exposure to 80° C. for 15 minutes upon the 
second day. This process is repeated the third and some- 
times the fourth day, at which time the media will be free 
from spores. 

Define Pathology. 

Pathology is that branch of medical science which treats 
of modifications of function and changes in structure caused 
by disease. 

Define leukomains. State where they are found. 

By leukomains are meant any of the nitrogenous bases or 
alkaloids normally developed by the metabolic activity of 
living organisms, as distinguished from the alkaloid a] sub- 
stances developed in dead bodies and called ptomains. 

They have been found in almost all of the tissues of the 
body. 

Mention the different kinds of tumors of the gums. 

Simple epulis (fibroma), malignant epulis (myeloid sar- 

(171) 



172 PATHOLOGY. 

coma), round-celled sarcoma, spindle-celled sarcoma, and 
epithelioma. 

State the difference between parasites and saprophytes. 

A parasite is an animal or vegetable organism living upon 
or within another living organism. 

A saprophyte is a vegetable organism living upon dead 
organic matter. 

How may inflammation terminate? 

Inflammation may terminate by resolution, retrogression 
(the formation of cicatricial tissue), suppuration, ulceration, 
or gangrene. 

Name the various tumors of the tongue. 

Papilloma, fibroma, lipoma, myxoma, angioma, lymphan- 
gioma, and epithelioma. Lymphadenoma and lymphosar- 
coma may occur at the root of the tongue. Chondroma has 
also been found in the submucous tissue of the tongue. 

What is the most common syphilitic lesion upon the 
tongue? 

Mucous patch. 

What is inflammation? 

Inflammation is the succession of changes which occur in 
a living tissue when it is injured, providing the injury is 
not of such a degree as to at once destroy its structure and 
vitality (Burdon Sanderson). It is "the response of living 
tissue to injury." 

Define sepsis, asepsis. 

Sepsis is a condition of poisoning produced by the ab- 
sorption of putrefactive substances. 

Asepsis is the absence of pathogenic micro-organisms. 

Give the differential diagnosis between sarcoma and 
carcinoma. 

A sarcoma arises from connective tissue, may occur at any 
age, may be encapsulated, gives metastasis through the blood- 



PATHOLOGY. 173 

vessels, and the overlying integument frequently contains 
dilated veins. 

A carcinoma arises from epithelial tissue, usually occurs 
after middle life, is never encapsulated, and gives metas- 
tasis through the lymphatic vessels. 

What is the difference between a ptomain and a toxin? 

A ptomain is a basic compound resembling the alkaloids, 
formed during the decomposition of animal or vegetable 
tissues. 

A toxin is any poisonous substance, either albuminous or 
basic, produced by the action of bacteria upon organic matter. 

A toxin is a poisonous ptomain. 

Give the pathology of sarcoma of the superior maxilla. 

Sarcoma originates from the anterior wall or from the 
cavity of the antrum or from the sphenomaxillary fossa be- 
hind the bone. The maxilla may be secondarily involved by 
sarcomatous naso-pharyngeal polypi which extend from the 
nose. These growths frequently contain considerable ossific 
deposits, and this is occasionally so extensive that the antral 
cavity is obliterated and the bone converted into a solid mass. 

Name tumors of the buccal parietes. 

Papilloma, naevus, cavernous angioma, and epithelioma. 

Mention four forms of abscesses. 

Acute or hot, chronic or cold, residual, and metastatic. 

What is an embolus? 

An embolus is a particle of fibrin or other material which 
is swept into the blood current and which is capable of 
forming an obstruction at its place of lodgment. 

What is an aneurism? Mention three varieties. 

An aneurism may be denned as a sac containing blood 
and communicating with the interior of an artery. 
Fusiform, saccular, and dissecting. 



171 PATHOLOGY. 

fl Mention five forms of inflammation. 

Fibrinous, diphtheritic, suppurative, hemorrhagic, and gan- 
grenous. 

What are the active agents in decomposition? 

The active agents in decomposition are the saprophytic 
bacteria. 

Define pasteurization. How does pasteurization differ 
from disinfection and sterilization? 

Pasteurization is a process of checking fermentation in 
organic fluids by heating them to 60° or 70° C. 

It differs from disinfection, since in disinfection, the bac- 
teria are destroyed by the use of chemical agents. 

It differs from sterilization, since in sterilization, the tem- 
perature is carried higher and the bacteria are destroyed, 
whereas in pasteurization the temperature is simply raised 
to a point where few fungi can flourish. 

Give the lesions in syphilitic affections of the buccal 
mucous membrane. 

The initial lesion (chancre) may rarely occur in this situa- 
tion. In secondary syphilis there is often a chronic inflam- 
mation of the buccal mucous membrane and mucous patches 
(mucous tubercles, condylomata) are not infrequently present. 

State what micro=organisms produce pus. 

Staphylococcus pyogenes aureus, staphylococcus pyogenes 
albus (staphylococcus epidermidis albus), staphylococcus pyo- 
genes citreus, streptococcus, bacillus coli communis, bacillus 
typhosus, pneumococcus, and gonococcus. 

Describe the structure of a bacterial cell. 

The cell is principally composed of an albuminous sub- 
stance known as mycoprotein. There is a large nucleus 
situated in the centre of the cell constituting its great bulk. 
This is surrounded by a very delicate cell-wall. In some 
bacteria, cilia or flagella may be observed extending away 
from the cell-wall. In other bacteria, the cell-wall seems to 



PATHOLOGY. lib 

undergo a gelatinous transformation so that the bacteria 
seem to be surrounded by a halo or capsule (pneumococcus). 

State the difference between benign and malignant 
tumors. 

Benign tumors are usually encapsulated, do not give metas- 
tasis, do not recur upon removal, produce no cachexia, grow 
slowly, do not infiltrate, are not painful (except by pres- 
sure), and do not cause death (except by location). 

Malignant tumors are never effectively encapsulated, give 
metastasis, recur upon removal, produce cachexia, usually 
grow rapidly, infiltrate, are painful, and cause death. 

What is the usual source from which pathogenic bac= 
teria are derived? State the conditions under which 
micro=organisms get into the air. 

Pathogenic bacteria are practically always derived in- 
directly from the bodies of diseased human beings or lower 
animals. They may be inhaled with the air (tuberculosis), 
ingested with the liquids or food (cholera and typhoid), or 
gain access through wounds. 

The micro-organisms get into the air from the soil. The 
excreta of diseased individuals becomes dried, ground up into 
dust, and these dust particles loaded with bacteria are dis- 
seminated by the winds. Micro-organisms rarely pass from 
fluids into the air. 

Describe a method of making gelatine plates. 

Three tubes of sterile gelatine are to be liquefied by heat. 
Tube No. 1 is inoculated with the infectious material by 
means of a platinum wire. Tube No. 2 is now inoculated 
from tube No. 1, and tube No. 3 is inoculated from tube 
No. 2. The contents of these tubes are now poured into 
three previously sterilized Petri dishes. In all of these 
manipulations, precautions must be taken to avoid accidental 
contamination of the culture medium. 

Differentiate thrombosis and embolism. 

By thrombosis is meant a clotting of the blood within the 



176 PATHOLOGY. 

heart or blood-vessels. It is due to a slowing of the current, 
or to an altered condition of the blood or blood-vessel walls. 
By embolism is meant the obstruction of a blood-vessel 
(particularly an artery) by a fragment of matter brought 
from another point. This fragment of matter or embolus 
may be a detached piece of a thrombus. 

How does suppuration spread? 

Suppuration spreads by the peptonization of the inflam- 
matory exudate by the pyogenic cocci. It spreads in the 
direction of least resistance. 

State the usual method of cultivating bacteria. 

The usual method of cultivating bacteria is to inoculate 
any of the ordinary culture media with the bacteria in ques- 
tion, and then to keep the media under conditions favorable 
for the growth of the micro-organisms. Bouillon, agar agar, 
potato, etc., may be kept in the brood-oven; gelatine is kept 
at room-temperature. 

Define oral pathology. 

Oral pathology is the study of the modifications of func- 
tion and changes in structure as they occur in the mouth 
and adjacent parts. 

Mention the principal diseases of the maxillary bones. 

Osteo-myelitis and its sequelae, alveolar abscesses, peri- 
ostitis, tuberculosis, syphilis (gummata), osteoma, chon- 
droma, fibroma, myxoma, carcinoma, sarcoma, and empyema 
(upper jaw). 

Describe the histologic structure of carcinoma. 

The structure will vary according to the region involved. 
The tumor is made up of epithelial cells and a stroma of 
connective tissue. In epithelioma of the skin, the cells are 
of a squamous type ; in carcinoma of mucous membranes, they 
are cylindrical and there is a tendency to the formation 
of cuboidal epithelium. The cells show secondary changes 
(dropsical infiltration, mucoid degeneration, fatty degenera- 






PATHOLOGY. Ill 

tion, etc.). Karyokinetic figures may be abundant and are 
frequently atypical. 

The epithelial cells are usually grouped into acini or into 
alveoli containing several layers of epithelial cells. At the 
periphery of the acini, the cells may break through the base- 
ment membrane. 

The connective tissue stroma is of varying density, but is 
always of a fibrous character. It is arranged so as to form 
hollow spaces which contain the epithelial cells. 

What are the active causes of carcinoma of the buccal 
cavity? 

Any irritation, such as smoking, a sharp tooth, the stem 
of a pipe, or a badly-fitting plate. Leukoplakia, chronic 
glossitis, and probably caustics. 

What is the cause of pain in inflammation? 

The pain in inflammation is caused by the exudate stretch- 
ing and pressing upon the filaments of the sensory nerves. 
Another factor in the production of inflammatory pain is the 
chemical irritation of the sensory filaments by the toxins 
produced by the bacteria. 

What is the difference between catarrhal and suppura- 
tive inflammation? 

In catarrhal inflammation there is usually considerable 
liquid exudation, retention cysts may form in the mucous 
glands, and even localized erosions may appear. There is a 
hypersecretion of mucus and a desquamation of epithelium. 

In suppurative inflammation, the exudate contains a large 
amount of leukocytes, which are killed and transformed into 
pus cells. 

What is periostitis? 

Periostitis is an inflammation of the periosteum. 
What is provisional callus, and where is it found? 

Provisional callus is the temporary splinting material 
which nature throws out about the ends of fractured bones. 
12 



178 PATHOLOGY. 

It is found outside of the ends of the fragments (ring 
callus) and within the medullary cavities of the fragments 
(pin callus). 

Give some of the pathologic and anatomic character 
istics of a benign tumor. 

Benign tumors usually resemble the tissue from which they 
grow, tend to unlimited growth, are encapsulated, do not 
adhere to surrounding structures, do not infiltrate, do not 
give rise to metastasis, do not recur when thoroughly re- 
moved, have a nutrition which is independent of the general 
nutrition of the body, and do not cause death (except mechan- 
ically) . 

What is meant by intermediate or definitive callus? 
Where is it found? 

Definitive callus is the callus which ultimately unites the 
fragments of fractured bone. It is the metamorphosis of 
this tissue that results in bony union. 

It is found between the ends of fractured bones. 

What effect has increased nutrition on tissues? 

It may result in fatty infiltration, in more rapid growth, 
or in hypertrophy. 

What effect has imperfect nutrition on tissues? 

It causes them to degenerate and atrophy. 

Differentiate between syphilitic and congenital cleft 
palate. 

Syphilitic perforation is practically always due to a broken- 
down gumma. There will be a history of preceding syphilis 
and concomitant lesions in some portion of the body. The 
perforation will have been accompanied by marked inflam- 
matory symptoms, well remembered by the individual. 

Congenital cleft palate is present at birth and is due to 
a failure of union of the two palatal processes. 



PATHOLOGY. 179 

Differentiate fibrous from sarcomatous epulis. 

Fibrous epulis grows slowly, is hard, painless, pale-red, 
and rarely attains a larger size than that of a walnut. 

Sarcomatous epulis grows rapidly, is softer, painful, livid 
in color, ulcerates sooner, and may attain the size of an apple- 
Mention the tumors of the buccal cavity. 
Fibroma, lipoma, myxoma, chondroma, osteoma, lympha- 
denoma, lymphosarcoma, spindle-celled sarcoma, myeloid sar- 
coma, papilloma, and carcinoma. 

Define abscess. State of what the walls of an abscess 
consist and describe its growth. 

An abscess is a circumscribed collection of pus in a cavity 
of abnormal formation. 

The walls consist of granulation tissue. 

The vessels of the affected area become dilated and the 
various elements of the blood pass through the walls. As the 
pyogenic organisms develop, retardation and stasis followed 
by thrombosis occur successively, whilst the exudation of cells 
becomes so great that the original tissue of the part disap- 
pears, after passing through a stage of coagulation necrosis. 
This removal of the infiltrated tissues is largely caused by 
their liquefaction, owing to the peptonizing power of the 
bacteria. 

State how a dead pulp may cause empyema of the 
maxillary sinus. 

The dead pulp may become infected and give rise to an 
alveolo-dental abscess, which ruptures into the maxillary sinus 
or causes a purulent inflammation of its lining by contiguity 
of structure. 

Define atrophy. Give the pathologic anatomy of atrophy. 

Atrophy is a reduction in bulk of one or more of the 
component parts of an organ, and the functional activity is 
reduced. 

The organ is reduced in size; its consistency may be in- 
creased; the outline of the organ may become irregular, and 



180 PATHOLOGY. 

there is an increase of pigment. The microscope shows a re- 
duction in the size of the individual cells. 

Give an effective method of sterilizing hypodermic 
syringes. 

The modern hypodermic syringe consists entirely of metal, 
and can be effectively sterilized by boiling it for five minutes 
in a 1% solution of sodium carbonate. 

If boiling water is drawn up into the old glass and metal 
syringe and then ejected, and this is repeated six or eight 
times, the syringe will be practically sterile. This method 
is more reliable than solutions of carbolic acid or bichloride 
(Eiselsberg). 

State in what manner micro=organisms enter the body. 

Through the respiratory tract, through the gastro-intestinal 
tract, through solutions of continuity of the skin and mucous 
membranes, and through the placenta, 

State the difference between asepsis and antisepsis. 

In asepsis, an effort is made to prevent the entrance of 
germs into a wound. The greatest reliance is placed upon 
mechanical purification and upon sterilization by heat. 

In antisepsis, an effort is made to destroy the germs in a 
wound as well as to prevent the entrance of more bacteria. 
The greatest reliance is placed upon chemical agents. 

How and under what conditions do bacteria multiply? 

Bacteria multiply by fission (direct division), and by 
sporulation (development of spores). 

The following conditions are requisite for the multiplica- 
tion of bacteria : 

1. Presence of oxygen (aerobic bacteria). Absence of 
oxygen (anaerobic). 

2. A certain amount of organic matter. 

3. A certain amount of moisture. 

4. A neutral or feebly alkaline reaction, for the majority 
of bacteria. 



PATHOLOG/. 181 

5. A temperature above 16° C. and below 40° C. 

6. The majority of bacteria multiply most rapidly when 
the medium in which they grow is at rest. 

Define antitoxin, virulent germ, non=viru!ent germ. 

An antitoxin is a counter poison elaborated by the body 
to counteract the toxins of bacteria. 

A virulent germ is one having marked pathogenetic prop- 
erties. 

A non-virulent germ is one, the pathogenetic properties of 
which are not marked. 

Differentiate hypertrophy and tumor. 

Hypertrophy is an increase in bulk of a tissue or organ 
occurring independently of the general growth of the body. 
In a true hypertrophy the function is increased. 

A tumor is an atypical new formation tending to unlim- 
ited growth, having no function, differing from the tissue 
in which it is found in gross and minute structure, the nutri- 
tion of which is independent of the nutrition of the body in 
general, and which is not dependent upon or coincident with 
inflammation. 

What are pathogenic bacteria? State how pathogenic 
bacteria incite disease processes. 

Pathogenic bacteria are those which produce disease. 

After gaining an entrance to the tissues, they may incite 
disease processes in one of the following ways: 

They may grow so rapidly that they completely block up 
the blood and lymphatic channels. 

They may cause a local inflammation, due partly to the 
presence of the foreign organisms and partly to their toxic 
metabolic products. 

More often, however, they produce powerful metabolic 
poisons, which destroy the tissues immediately acted upon, 
or circulate through the organisms and overthrow the normal 
physiologic equilibrium. 



182 PATHOLOGY. 

Define carcinoma. Give with reference to carcinoma 
(a) congenita! theory, (b) traumatic theory, (c) clinical 
appearance. 

A carcinoma is a malignant epithelial tumor, composed of 
a connective tissue stroma, surrounding groups or nests of 
epithelial cells. 

(a) Congenital theory. — The carcinoma is supposed to 
grow from embryonal rests or "resting spores." 

(b) Traumatic theory. — The carcinoma develops as the 
result of a single traumatism or of repeated irritations. 

(c) Clinical appearance. — The tumor occurs in an indi- 
vidual past middle life, is fixed to the surrounding tissues, 
and may be ulcerated. The neighboring lymphatic glands 
are enlarged, the tumor is the seat of lancinating pain, and 
cachexia is present. 

Distinguish between pathologic regeneration and physi= 
ologic regeneration. 

Physiologic regeneration is that which occurs in the nor- 
mal life of the organism, and by which the cellular wear and 
tear is counterbalanced. The tissue destroyed is replaced by 
similar tissues. 

Pathologic regeneration is the more massive and open 
atypical reconstruction that follows disease or injuries. The 
tissue destroyed is almost always replaced by connective tissue. 

What is disinfection? How may the strength of a dis= 
infectant be determined? 

Disinfection is the destruction of micro-organisms, partic- 
ularly by the action of chemicals. 

The strength of a disinfectant may be determined by 
bringing definite quantities of the infected material in con- 
tact with definite quantities of a series of solutions of graded 
strengths, and subsequently making cultures from the in- 
fected material, which has been thus exposed, to determine 
whether the organisms have been completely destroyed. 



PATHOLOGY. 183 

How do wounds heal? 

Wounds heal: 

1. By immediate union. 

2. By first intention. 

3. By organization of a blood clot. 

4. Under a scab. 

5. By second intention (granulation). 

6. By third intention (adhesion of granulating surfaces). 
By the first four methods the wound heals without the for- 
mation of pus ; in the last two methods suppuration is present. 

Mention the different varieties of tumors of the supe= 
rior maxilla. 

Myxoma, fibroma, chondroma, osteoma, odontoma, sarcoma, 
and carcinoma. 

Define pus. Give the specific gravity and varieties 
of pus. 

Pus is a thick, opaque, creamy fluid; it is smooth and 
slightly glutinous to the touch, has a faint odor and a slightly 
sweetish taste. It is neutral or feebly alkaline in reaction. 

The specific gravity of pus varies between 1021 and 1042. 

The varieties of pus are : The so-called healthy pus, ichorous 
pus, sanious pus, fetid pus, curdy pus, muco-pus, and sero-pus. 

Define suppuration. 

By suppuration is meant the formation of pus. 

Define diathesis. 

A state or condition of the body whereby it is especially 
liable to certain diseases. It may be acquired or hereditary. 

Define cachexia. 

A depraved condition of general nutrition due to some 
serious disease, such as syphilis, tuberculosis, carcinoma. 

Into what classes are bacteria divided? 

According to their morphology, bacteria are divided into: 
(1) Cocci, (2) Bacilli, (3) Spirilla. These are relatively 



184 PATHOLOGY. 

monomorphous. Three other varieties might be mentioned: 
(4) Spirulina, (5) Leptothrix, (6) Cladothrix. These are 
relatively pleomorphous. 

Define plethora, anemia, hyperemia. 

By plethora is meant an increase of the total amount of 
the blood in the body. 

By anemia is meant a deficiency of the blood as a whole, 
a deficiency of the red corpuscles, or of the hemoglobin. 

By hyperemia is meant an increased amount of blood in 
the more or less dilated vessels of a part. 

Describe (a) local hyperemia; (b) passive hyperemia. 

All hyperemias are local. By hyperemia is meant an in- 
creased amount of blood in the more or less dilated vessels 
of a part. 

By passive hyperemia is meant an increased amount of 
blood in the more or less dilated veins and capillaries of a 
part with diminished velocity of the blood stream. The part 
is bluish and swollen. Nutrition, function, and temperature 
are all decreased. 

Define hemorrhage. 

By hemorrhage is meant the escape of the several con- 
stituents of the blood from the blood-vessels. 

What is meant by chromogenic and pyogenic bacteria? 

Chromogenic bacteria are those which produce colored 
colonies or impart color to the medium in which they grow. 
Pyogenic bacteria are those capable of producing pus. 

What is a culture medium? What is a pure culture? 

A culture medium is a mixture in which it is possible to 
cultivate bacteria. 

A pure culture is a culture of a single species of bacteria. 

What are toxalbumins? 

Toxalbumins are toxic substances produced by either ani- 
mal or vegetable cells. They are albuminous in character, 
giving the ordinary reactions for albumin. 



PATHOLOGY. 185 

Distinguish between cocci, bacilli, and spirilla. 

Cocci are bacteria having a spherical shape. 
Bacilli are elongated or rod-shaped bacteria. 
Spirilla are bacteria having a spiral shape and bear some 
resemblance to a cork-screw. 

State why the mouth is a favorable place for the 
development of bacteria. 

Because heat, moisture, oxygen, and decomposing organic 
matter are constantly present. 

Name the classification of cocci from the number and 
order of arrangement of the cells. 

Diplococei, tetragenococci, merismopedia, sarcina, strep- 
tococci, streptodiplococci, and staphylococci. 

Differentiate between aerobic, anaerobic, and faculta= 
tive bacteria. 

Aerobic bacteria are those which grow in the presence of 
oxygen. 

Anaerobic bacteria are those which do not grow in the 
presence of oxygen. 

Facultative bacteria are those which grow either with or 
without oxygen. 

Define general pathology; special pathology. 

General pathology is the study of morbid processes in gen- 
eral without reference to the individual organs. 

Special pathology is the study of morbid processes in the 
individual organs. 

State what is meant by (a) the predisposing cause of 
disease; (b) the exciting cause of disease. 

A predisposing cause of disease is one which places the 
individual in a condition favoring the action of the exciting 
cause ; it prepares the system or part by rendering it weaker 
and less resistant. 

The exciting cause of disease is the immediate or specific 
cause of the disease. 



186 PATHOLOGY. 

Classify the diseases due to bacteria. 

The following is the classification of McFarland: 

A. The Phlogistic Diseases. 

1. The Acute Inflammatory Diseases, suppuration. 

2. The Chronic Inflammatory Diseases, (a) Tuberculosis; 

(b) Leprosy; (c) Glanders; (d) Syphilis; (e) Actinomy- 
cosis; (/) Mycetoma or Madura-foot; (g) Farcin du Boeuf ; 
(h) Rhinoscleroma. 

B. The Toxic Diseases. (a) Diphtheria; (&) Tetanus; 

(c) Hydrophobia or rabies; (d) Symptomatic anthrax; (e) 
Typhoid fever; (/) Cholera; (g) Pneumonia. 

C. The Septic Diseases, (a) Relapsing fever; (&) Influ- 
enza; (c) Malignant Edema; (d) Measles; (e) Bubonic 
Plague; (/) Tetragenus; (g) Chicken Cholera; (h) Mouse 
Septicemia; (i) Anthrax; (j) Typhus Murium. 

Mention the pathologic changes in gangrenous stom= 
atitis. 

The pathologic changes are those of a rapid necrosis of all 
the tissues; the micro-organisms of suppuration and putre- 
faction are present. Putrefactive changes are always in evi- 
dence ; intense septic infection and intoxication are almost 
always observed. 

From what do cysts of the alveolar process arise? 

Dental cysts are inflammatory in their origin and are 
formed in connection with the fang of a tooth. 

Dentigerous cysts arise from imperfectly developed teeth 
which have been retained in the jaw. 

Multilocular cysts may be either fibrocystic tumors or cysts 
developed in adenomatous or sarcomatous tissues. 

Describe the process of repair of fractures. 

In a simple fracture the ends of a broken bone and the 
contiguous lacerated tissues are immediately surrounded by 
a clot of blood. As a result of simple traumatic inflamma- 
tion, exudation occurs and the clot is invaded by leucocytes, 



PATHOLOGY. 187 

which absorb it and the damaged tissues. There now occurs 
an infiltration of large plasma cells derived from a multipli- 
cation of the pre-existing connective tissue cells of the part. 
Vessels grow into this tissue from the surrounding parts so 
that it becomes organized and converted into granulation 
tissue, which is known as callus. The plasma cells destroy 
the emigrated leucocytes and are converted into fibrous tissue, 
which contracts and obliterates the vessel. This scar tissue 
now undergoes calcification and ossification. The intercel- 
lular substance increases in quantity, the cells become an- 
gular, resembling osteoblasts, lime salts are deposited around 
them, and true bone is formed in the same manner as in the 
usual process of ossification. 

Mention and explain the causes of inflammation. 

The predisposing causes of inflammation are those which 
depress the vital powers and render the individual more 
susceptible to the action of the exciting causes. The pre- 
disposing causes of inflammation are hereditary tendencies, 
bad habits, faulty hygiene, and dietetic errors, diminished 
innervation, organic visceral disease, and certain states of the 
blood (such as anemia). 

The exciting causes of inflammation are the immediate or 
specific causes of the inflammation. These are: (1) Direct 
injury (mechanical, chemical, physical) ; (2) the chemical 
products of putrefaction; (3) infective micro-organisms. 

What is meant by regeneration of tissue and how is it 
brought about? 

By regeneration is meant the formation of new cells or 
tissues to take the place of those destroyed. 

Physiologic regeneration is brought about by a process of 
gradual cell-multiplication without marked changes of any 
sort. 

Pathologic regeneration is brought about by the process of 
inflammation. 



188 PATHOLOGY. 

Define (a) etiology, (b) morbid anatomy, (c) diagnosis, 
(d) prognosis. 

Etiology is that branch of pathology which treats of the 
causation of disease. 

Morbid anatomy is that branch of pathology which treats 
of the changes of structure and form that take place in 
diseased conditions. 

Diagnosis is the determination of the nature of a disease 
by a study of its symptoms. 

Prognosis is a judgment in advance concerning the dura- 
tion, course, and termination of a disease. 

What pathologic conditions may be caused by an im= 
pacted third molar? 

Hypertrophy of the pericementum, pressure-resorption of 
adjacent roots, the formation of a capsule of new bone about 
the impacted tooth, infringement of the root-apex upon the 
inferior dental vessels and nerve, and necrosis of the bone. 

What is fermentation? What causes it? 

Fermentation is the decomposition of complex molecules 
under the influence of ferments. 

Fermentation is caused by enzymes, yeasts, and bacteria. 

What precautions should be taken to prevent septic 
infection? 

The wound or operative area should be made as sterile as 
possible and no septic substance should be allowed to come 
in contact with it subsequently. Asepsis is secured by 
mechanical purification, sterilization by heat, chemical dis- 
infection, or by some combination of the three methods. 

What is the cause of an apical alveolar abscess? De- 
scribe the process of its formation. 

The infection of the pericementum by pyogenic organisms. 
The purulent apical pericementitis is almost always pre- 
ceded by death and putrefaction of the pulp, but consider- 



PATHOLOGY. 189 

able purulent destruction of the pericementum may occur 
near the apex of the tooth and the pulp of the tooth remain 
alive for a short time. In the latter case the path of in- 
fection is unknown, but the pyogenic organisms may be 
carried here by the blood from a distant focus of suppuration. 
An abundant exudate is poured out into the interstices of 
the pericementum, the leucocytes die and form pus cells, the 
exudate is peptonized, and we have all the phenomena of 
abscess formation in other situations. 

What are salivary calculi? What conditions are pro= 
duced by them? 

Salivary calculi are hard concretions composed of the cal- 
cium salts of the saliva which have been precipitated and 
combined with organic substances (usually mucin). 

When situated in the salivary ducts, calculi may cause 
retention of saliva with inflammatory phenomena tending to 
abscess and subsequent salivary fistula. 

When situated upon the teeth, they may cause gingivitis, 
absorption of the gum, destruction of the alveolus, or an 
ulcer of the tongue. 

What is the difference between a tumor and an in- 
flammatory swelling? 

The reader is referred to the definitions of tumor and in- 
flammation given in answer to some of the preceding ques- 
tions. To differentiate these conditions further, it might be 
said that tumors are almost always unaccompanied by fever, 
unless there is some intercurrent infection, and that the tumor 
is not characterized by a local increase of temperature unless 
it is of very rapid growth. The benign tumors do not give 
rise to pain (unless by pressure), and the pain of a malig- 
nant tumor differs in character from that of inflammation. 
The swelling is usually more acute in the inflammation than 
in the tumor. Redness may be entirely absent in the neo- 
plasm. 



190 PATHOLOGY. 

Mention the varieties of pathogenic bacteria found in 
the air. 

The particular variety depends entirely upon the sur- 
roundings. The air of stables is apt to contain tetanus 
bacilli and possibly the bacillus of malignant edema. The 
air of a room in which a tubercular patient is kept may 
contain the tubercle bacillus, particularly if the sputum dries 
and is ground up and disseminated by the dust. The air of 
hospital wards may contain any of the bacteria producing 
infectious diseases or suppuration. 

Describe the characteristics of carcinomatous ulcer. 
Give the cause of putrefaction of carcinomatous ulcer. 

Epitheliomatous ulcers occur in individuals at or past 
middle life. They commence as a wart or fissure and stead- 
ily progress. The base of the ulcer bleeds easily; it is in- 
durated, uneven, and covered with firm, pink granulations 
containing small, yellow specks. The edges are indurated 
and everted. The neighboring lymphatic glands enlarge 
after a time and become adherent to each other and to the 
overlying skin. Early in the disease the secretion is scanty 
and viscid and pain may be entirely absent. 

If the epithelioma is deep-seated, it commences as a red- 
dish tubercle, which breaks down into an irregular ulcer with 
a foul, bleeding, indurated base. Pain is often severe, and 
lymphatic involvement occurs earlier than in the more super- 
ficial variety first described, but is not so precocious as in 
the other forms of carcinoma. 

Carcinomatous ulcers also result from the breaking down 
of deep-seated carcinomata. They vary with the structure 
of the tumor and may be fungating or excavated. They are 
always attended by pain, involvement of the neighboring 
lymphatic glands, foul discharge, and cachexia. 

Putrefaction in a carcinomatous ulcer is due to the same 
causes as putrefaction elsewhere, i. e., the presence of 
saprophytes and dead organic matter. The malignant neo- 
plasm outgrows its circulation, a portion necessarily dies, and 



PATHOLOGY. 191 

this dead organic matter is attacked by the saprophytes. 
The heat, oxygen, and moisture which are always present, 
aid in the process. 

Name two culture media. 

Gelatin and agar-agar. 

What is a sanguinary or serumal calculus? 

A sanguinary or serumal calculus is a hard dark calculus 
which may be deposited anywhere between the neck of the 
tooth and the apex of the root. As indicated by the name, 
it is derived from the blood instead of from the saliva. 

What are phleboliths? 

Literally, "vein-stones." The term is applied to concre- 
tions formed in the veins. They usually consist of dense, 
fibrous bodies, the result of calcification following a venous 
thrombus. 

What is exostosis? 

It is a circumscribed overgrowth of the cementum, ex- 
tending beyond the line of the fang of the tooth and giving 
an irregular outline to its external surface. 



PATHOLOGY AND THERAPEUTICS. 



What changes occur in inflammation? 

Primarily. — A marked increase in the velocity of the 
blood-current and a dilatation of the vessels (arteries and 
capillaries), caused by a stimulation of the vaso-dilator, or a 
paralysis of the vaso-constrictor, nerves, followed by a de- 
crease in the velocity of the blood and increased pressure with 
heightened temperature and redness. Leucocytes collect 
along the walls of the vessels and migrate through them by a 
process called diapedesis. Exudates pour into the intercellu- 
lar spaces and the part becomes swollen, causing pain by 
pressure upon the nerve filaments. If resolution occurs, the 
inflammatory effusions will be taken up by the lymphatics 
and the part restored to health. If, on the other hand, sup- 
puration occurs, death of the part, or necrosis, may follow. 

What is septicemia and what causes it? 

It is a condition in which septic matter gains access to the 
circulating fluids of the body, caused by the absorption of 
the toxins produced by bacteria. 

How do you treat putrescent pulps? 

The contents of the pulp cavity and canals should be steri- 
lized with a ten per cent, solution of formalin, after which 
the pulp should be removed with sterilized broaches, great 
care being exercised not to force any of the canal contents 
into the apical space. Canals should then be thoroughly 
cleansed with sodium dioxide, followed by an application of 
dilute sulphuric acid. Neutralize the acid with a bicarbon- 
ate of soda solution, dry with absolute alcohol and fill canals 
with antiseptics on cotton, or fill permanently as indicated. 
13 (193) 



194 PATHOLOGY AND THERAPEUTICS. 

What symptoms indicate diseases of the dental pulp? 

Paroxysms of pain upon application of thermal test, in- 
creased pain upon assuming a recumbent position, neuralgic 
pain along the course of the fifth nerve. 

Why is a pulp capped? When? How? 

To preserve its vitality. In young patients when the 
pulp has been exposed by accident in excavating. Make a 
concave disc of gold, platinum, tin or copper, large enough 
to completely cover the exposure; fill the disc with a paste 
made from zinc oxide and one of the essential oils, place this 
over the exposure and seal over with zinc oxysulphate. Cover 
the whole with a temporary filling. If pulp continues vital 
and normal for three or six months, it is reasonably safe 
to insert a permanent filling. 

Which tissue of the tooth dies with the pulp, and which 
remains alive? 

The dentine dies with the pulp, and the cementum re- 
mains alive. 

What are parasitic bacteria, and how do they cause 
disease? 

Parasitic bacteria are those forms which subsist upon liv- 
ing animal tissue, producing toxins, which, when taken into 
the circulation, cause disease. 

How does mercuric chloride act as an antiseptic? 

Mercuric chloride acts as an antiseptic by destroying 
bacteria. The mercury in the compound when brought into 
contact with albuminous substances, combines with the al- 
bumin, thereby destroying its identity, as well as its vitality. 

What are some of the manifestations of pathological 
dentition? 

In deciduous pathological dentition, we may have gastro- 
intestinal disturbances, marked stomatitis and, in severe 
cases, convulsions may occur. In permanent dentition, some 
of the pathological conditions most frequently met with are 



PATHOLOGY AND THERAPEUTICS. 195 

impaction or eruption in malposition of third molars, im- 
paction of lateral incisors, supernumerary teeth, fusion, irre- 
gularities as to the number of cusps, odontoceles and dentiger- 
ous cysts. 

What are the principles of treatment in dental caries? 

The employment of an alkaline solution to neutralize acids 
present, removal of carious tissue, the destruction of micro- 
organisms by the use of germicides, and the hermetical seal- 
ing of the cavity by means of filling materials. 

What is the danger of chronic septic pericementitis, 
and what is the treatment? 

The danger is the opening of the pus cavity upon the face, 
or the infiltration of pus into the tissues surrounding the 
tooth, causing necrosis of the pericemental membrane and loss 
of tooth. The treatment consists of the mechanical removal 
by warm water of pus masses and the antiseptic treatment of 
the affected part, after which mild stimulation should be em- 
ployed to hasten formation of granulation tissue. 

Name four agents used in acute diseases of the pulp and 
give the physiological action of each. 

Tr. Aconite administered in one drop doses reduces the 
force of the circulation and acts as a sedative to the nervous 
system. 

Carbolic acid, being antiseptic and sedative in its action, 
may be used in cases of hyperaemia of the pulp. A saturated 
solution of menthol in chloroform, if placed in a cavity of a 
tooth exhibiting symptoms of pulpitis (acute), has an anesthe- 
tic and antiseptic effect. 

A paste of cocaine and glycerine may also be used in 
cases of pulpitis, which acts as an analgesic. 

What causes an alveolar abscess? 

Access of septic matter to the apical space, or direct 
bacterial invasion of that area during an attack of apical 
pericementitis. 



196 PATHOLOGY AND THERAPEUTICS. 

What is phagedenic pericementitis? 

A disease of the pericemental membrane producing necrosis 
of that organ. In this particular condition, calcareous de- 
posits may be present, and gingivitis may not be marked. 

How do you diagnose exostosis? 

Exostosis is accompanied by the presence of vaguely re- 
flected pains, it being usually impossible to locate the seat 
of the trouble; the X-ray, however, demonstrates the condi- 
tion very efficiently. 

What causes induce periodontitis? 

Traumatism and septic infection. 

What dangers are to be apprehended from abscess upon 
the temporary teeth? 

Pus gaining access to the follicle of the permanent successor, 
interfering with its development. Non-resorption of the de- 
ciduous root causing mal-eruption of permanent tooth. 
Possible necessity for premature extraction of the tempor- 
ary tooth, resulting in impaction or mal-eruption of per- 
manent tooth. 

What results are likely to follow abrasion of the teeth? 

Heightened sensitivity of the dentine, and deposits of 
secondary dentine in the pulp cavity. 

What causes superinduce the devitalization of non= 
carious teeth? 

Traumatism, causing severe hyperemia and death of the 
pulp by strangulation. This includes too rapid wedging, as 
well as too rapid movement in regulating cases. 

How would you conduct a thermal test to locate an in- 
flamed pulp? 

By isolating each tooth with rubber dam and projecting 
against it, alternately, jets of cold and hot water, until the 
offending member has been located by an exaggerated re- 
sponse to the test. 



PATHOLOGY AND THERAPEUTICS. 197 

Give some causes of necrosis. 

Thrombus in a terminal artery; or, ligation of a vessel 
cutting off the supply of nutrition to the part. 

Which of the permanent teeth are most liable to patho= 
logical eruption, and why? 

The upper and lower third molars. The former frequently 
erupt with their occlusal faces directed toward the cheek ow- 
ing to an insufficient space between the second molars and 
the pterygoid processes for their accommodation normally 
within the arch. The lower third molars are more frequently 
retarded in their eruption, also due to lack of space. 

Describe epulis within tooth cavity. Describe fungoid 
pulp. 

Epulis within a tooth cavity is a pedunculated fibrous 
growth gaining access to the cavity usually through an open- 
ing at the bifurcation of the roots of molar teeth. This 
opening is caused by caries. The condition resembles very 
closely fungoid pulp, a hypertrophic condition of the pulp 
which is fibrous in character and highly vascular. 

In what abnormal condition will resorption of the tem= 
porary teeth cease? 

In temporary teeth containing putrescent pulps, or a peri- 
cemental membrane in a suppurating condition, resorption 
may not occur. 

Describe and give the supposed cause for Hutchinson's 
teeth. 

Hutchinson's teeth present a notched appearance upon 
the cutting edges, the longitudinal axis of these edges being 
shortened. The supposed cause is congenital syphilis. 

How is pulp irritation from loss of tooth substance dis= 
tinguished from sensitive dentine? 

If exaggerated pain is experienced from contact with in- 
struments upon the abraded surface, the condition is that of 
hypersensitive dentine. If this contact causes but a mild 



198 PATHOLOGY AND THERAPEUTICS. 

response and the thermal test produces marked paroxysms of 
pain, the condition may be diagnosed as irritation of the pulp. 

What results may follow the premature extraction of 
the temporary molars? 

The first permanent molar may tip forward and occupy 
the space which the second bicuspid should take upon erup- 
tion, thereby causing either mal-eruption or impaction of the 
bicuspid tooth. 

How would you differentiate between pericementitis 
and alveolar abscess? 

In pericementitis, the pericemental membrane becomes 
thickened, the tooth elongated and extremely sensitive to per- 
cussion. A reddening of the gum tissue is noted over the 
affected tooth. In alveolar abscess we have an exaggerated 
likeness to these symptoms together with swelling over the 
affected tooth, intense pain with a subsequent discharge of 
pus. 

Name some of the pathological conditions of the dental 
pulp. 

Passive and active hyperaemia, pulpitis, pulp nodules, dry 
and moist gangrene, and pulp hypertrophy. 

Give the cause of dental exostosis and describe the 
symptoms. 

The cause of dental exostosis may be extraction of the 
occluding tooth, the pericementum not being met by the ac- 
customed resistance, proliferates cementum upon the apex 
of the root. Or, traumatic injury, causing continued mild 
irritation of the pericementum, may give rise to a like condi- 
tion. The symptoms are vague pains about the affected tooth, 
sometimes assuming a reflected neuralgic type. 

How would you diagnose and locate an inflamed pulp 
where no cavity exists? 

Bv the thermal test. 



PATHOLOGY AND THERAPEUTICS. 199 

What are bacteria? 

Bacteria are minute organisms representing the lowest or- 
der of plant life. 

Give the symptoms of septicemia. 

The general symptoms of septicemia are fever and chills, 
diarrhoea, rapid and weak pulse and clammy condition of the 
skin. If the infection has been from a wound, the discharge 
coming from it will be putrid. 

What conditions are necessary for the growth and de= 
velopment of bacteria? 

Proper food supply, removal of waste products, moisture, 
sufficient temperature and the presence of free oxygen. This 
last-named condition, however, is not necessary for the exist- 
ence of the anaerobic bacteria. 

Give Miller's theory of dental caries. 

The presence of sugar in the mouth causes fermentation and 
the production of lactic acid which dissolves out the lime con- 
stituents of the teeth. Micro-organisms gain access to the 
dentinal tubuli and proliferate; they follow in the wake of 
the decalcifying process and subsist upon the organic tooth 
substance, producing acids. 

By what and under what conditions is pus produced? 

Pus is produced by the invasion of the staphylococcus 
pyogenes aureus, citreus or albus, or by streptococcus pyo- 
genes, the gonococcus, the bacillus pneumonae or other pyo- 
genic organisms into an area susceptible to inflammatory 
changes, or already inflamed. The white blood corpuscles to- 
gether with other wandering cells of the body, are devital- 
ized by the bacteria and become pus corpuscles. 

What are leucocytes and what are their functions? 

Leucocytes are the white blood corpuscles. They exercise 
phagocytic activity, devouring and carrying away invading 
bacteria and other irritating organic substances which gain 
access to the tissues. 



200 PATHOLOGY AND THERAPEUTICS. 

Name some of the pathogenic fungi found in the mouth. 

Micrococcus of sputum septicemia. 
Bacillus salivarius septicus. 
Micrococcus gingivae pyogenes. 
Saccharomyces albicans. 
Pneumo-bacillus. 

What is meant by lactic fermentation and why is it of 
extreme interest to dentists? 

Lactic fermentation is that process or change which occurs 
in solutions of the fermentable carbohydrates, producing 
lactic acid. This product is of interest to dentists, as it is 
the prime factor in the production of dental caries. 

What effects may be produced in the mouth from the 
administration of large doses of calomel? Describe the 
condition. 

Large doses of calomel produce a condition known as mer- 
curial stomatitis. The gums around the necks of the teeth 
become inflamed and swollen, ulceration of the mucous mem- 
brane occurs, the teeth become loosened, and there is a marked 
increase in the flow of saliva. The breath is fetid, and there is 
an unpleasant metallic taste in the mouth. The severity of 
these, symptoms depends upon the susceptibility of the patient, 
as, in some cases, loss of the teeth occurs, and even necrosis 
of the maxillary bones. 

Differentiate between hyperaemia, inflammation and 
suppuration. 

Llyperaemia is an excess of blood in a part. Inflammation 
is the succession of changes (hyperaemia being one of these 
changes) which occur in a tissue during its effort to rid itself 
of an irritant, provided the irritant is not of sufficient strength 
to cause immediate death of the part. If, in the last stages of 
inflammation, resolution does not occur, and pyogenic or- 
ganisms invade the inflamed area, suppuration, or the forma- 
tion of pus, will occur. 



PATHOLOGY AND THERAPEUTICS. 201 

What is the source of nourishment of bacteria? How 
do they obtain oxygen. 

Bacteria contain no chlorophyl, and, therefore, have not the 
power to decompose water and carbon dioxide to effect the 
synthesis of starch. Hence, they are compelled to derive their 
nourishment from organic compounds. According to their 
method of obtaining oxygen, bacteria are divided into three 
classes: aerobic, those depending upon the presence of free 
oxygen; anaerobic, those not requiring free oxygen, as they 
possess the pow r er to appropriate the oxygen from unstable 
organic compounds; and facultative, or those which flourish 
in either condition. 

What is salivary calculus, where is it found, and what 
effect has it? 

Salivary calculus is a deposition of the salts of lime (car- 
bonate and phosphate), held in solution in the saliva, upon the 
surfaces of the teeth, usually near the gum margin, in proxi- 
mal spaces and deep sulci. Carbon dioxide plays an active 
part in the precipitation of the calculus. Large deposits 
are frequently found near Steno's duct, the opening of the 
parotid gland, and on the lingual and labial surfaces of the 
lower anterior teeth. Deposits of tartar have the effect of 
producing recession of the gum, causing sufficient irritation 
at times to produce inflammation and even suppuration. If 
allowed to continue, the deposits may be responsible for affec- 
tions of the pericemental membrane and alveolar process, and 
also tooth loss. 

What is the difference between an antiseptic and a 
germicide, and give examples? 

Antiseptics prevent the action of pathogenic organisms and 
their products on the living body, but do not necessarily kill 
the micro-organisms. Germicides destroy the vitality of the 
germs of disease. Germicides are antiseptics, though anti- 
septics are not necessarily germicides. Iodoform is an anti- 
septic: mercuric chloride is a germicide. 



202 PATHOLOGY AND THERAPEUTICS. 

What is pyrozone? How does it act, and for what 
is it used? 

Pyrozone is a solution of hydrogen dioxide in water or 
ether. A 3% aqueous solution acts as an antiseptic and dis- 
infectant; these properties are due to the setting free of 
oxygen when the solution is brought in contact with organic 
matter. In this strength, it is valuable in cases of ulcerative 
stomatitis, and also in softening deposits of calculus. For 
cleansing pus pockets, it is an effective agent. A 25% 
ethereal solution is used as a bleaching agent, caustic and 
styptic. 

How are the diseases of the pericementum diagnosed 
from those of the pulp? 

Diseases of the pericementum respond freely in paroxysms 
of pain to any pressure brought to bear upon the tooth, while 
the pulp disorders are demonstrated by the thermal test. 
Pericemental disorders can always be located by the patient. 
Pains from pulp affections are more often reflected. When 
one is complicated by the presence of the other both symp- 
toms may be in evidence. 

At what age is the first permanent tooth erupted, and 
which tooth is it? 

The first permanent tooth is erupted at about the sixth 
year ; it is called the first molar, or sixth year molar. 

How do you treat hypersensitive dentine? 

In the treatment of hypersensitive dentine the rubber dam 
should be applied if possible and absolute dryness secured. 
This, in itself, ofttimes produces sufficient anaesthesia to per- 
mit instrumentation. In obstinate cases, however, it may 
be necessary to employ other therapeutic measures. If the 
cavity be not deep, a solution of caustic soda (ten grains to 
the ounce of water) is sometimes effective. A paste of cocaine 
muriate and glycerine, sealed in the cavity for 24 hours, may 
be used with good results. Cocaine may also be employed 
by cataphoresis. Carbolic acid, chloroform, ethyl or methyl 



PATHOLOGY AND THERAPEUTICS. 203 

chloride (in spray) are also indicated. In cases of hyper- 
sensitivity of abraded teeth (where no cavity exists), the tooth 
or teeth should be isolated by the rubber dam and strong 
mineral acids, such as nitric, sulphuric and hydrochloric 
applied. These agents coagulate the contents of the tubules. 
The surfaces, treated in this manner, should always be ex- 
cavated and filled. 

What dangers must be guarded against in the use of 
arsenic for devitalizing the pulp of a tooth? 

Arsenic, for the purpose of devitalizing the pulp, should 
be employed with great care. If possible the tooth should be 
isolated with rubber dam. If carelessly applied, a minute 
portion of arsenic may come in contact with the gum tissue 
or be insinuated in the gingival space, producing sloughing 
of the peridental membrane and gum tissue, or necrosis of 
the process, or both. Great care should be exercised in seal- 
ing arsenic in a cavity to prepare the margins of the cavity 
in such a way as to permit hermetical sealing. Pastes of 
arsenic should be applied without an excess of fluid, as there 
is danger of oozing about the margins during the process of 
sealing. This drug should never be used for the devitaliza- 
tion of pulps in deciduous teeth. 

Give the differential diagnosis between hyperaemia, in= 
flammation and suppuration of the pulp. 

In hyperaemia the pulp responds to the application of heat 
or cold in a somewhat exaggerated degree, owing to the 
dilatation of the vessels. Cases of hyperaemia usually give a 
history of mild attacks of odontalgia, transient in character. 
In inflammation of the pulp the response to cold is somewhat 
diminished ; the application of heat produces pain of a severe 
type. Odontalgia becomes constant, throbbing in character, 
increasing when the patient assumes a recumbent position. 
Neuralgic pains may be felt along the course of the fifth nerve. 
Suppuration begins in the late stage of inflammation, and is 
indicated by a cessation of response to cold applications. 
Heat produces agonizing paroxysms of pain, only alleviated by 



204 PATHOLOGY AND THERAPEUTICS. 

the immediate application of cold. The pain now assumes 
a gnawing character, persistently increasing, while throbbing 
ceases. 

What are saprophytic bacteria, and how do they cause 
disease? 

Saprophytic bacteria are those forms which nourish upon 
dead organic substances, effecting their decomposition, and 
producing poisons, through the agency of which they become 
causes of disease. 

What objections are there to the premature extraction 
of the temporary teeth? 

Premature extraction of the temporary teeth is followed by 
insufficient space for the normal eruption of their permanent 
successors, resulting in malposed permanent teeth, and, not 
infrequently, their impaction. 

How do you distinguish erosion of the teeth and caries? 

Erosion is characterized by cupped out cavities with hard, 
glossy surfaces usually on the labial aspects of teeth, while 
caries presents a softening of the tooth structure. Caries 
may follow erosion. 

How is the destruction of tissue brought about in dental 
caries? 

The product of lactic fermentation (lactic acid) decalcifies 
the tooth at a vulnerable point, and the micro-organisms of the 

mouth attack and destroy the organic remains. 

What is resorption of the roots of deciduous teeth? Is 
it a ph3'siological or pathological condition? 

Resorption of the roots of deciduous teeth is a physiological 
process brought about by the phagocytic action of multi- 
nucleated cells, these cells secrete a ferment, which liquefies the 
roots, and in this condition they are taken up by the lym- 
phatics. In short it is nature's method of preparing a path 
for the eruption of the permanent successors. 



PATHOLOGY AND THERAPEUTICS. 205 

Describe the pathologic changes which occur in the 
dental pulp starting from irritation and ending in pus 
formation. 

Pulp irritation may result from traumatism, excessive 
thermal stimuli, drug action, or infection. Active hyper- 
aemia of the pulp occurs with a marked dilatation of 
the arteries and arterial capillaries. If the cause of 
the irritation is not removed, the white blood cells in these 
vessels collect along the walls in* great numbers, thereby im- 
peding the flow of the blood stream. If dilatation occurs in 
the arteries near the apex of the tooth, the return flow of the 
blood is cut off by an impingement of the engorged arteries 
upon the apical veins. Diapedesis now occurs and the white 
blood cells, together with effusions of inflammation, are poured 
out into interstitial spaces. This phenomenon marks the on- 
set of pulpitis. If the pulp be infected by pyogenic organ- 
isms, the lencocytes are overpowered and die, becoming pus 
corpuscles. 

Why should deciduous teeth receive early and system- 
atic treatment? 

Deciduous teeth should receive systematic treatment, be- 
cause their retention in the arch until the time of eruption 
of their permanent successors, has much to do with the 
normal eruption of these latter. 

What effect may be produced on the dental pulp by con* 
tinued mild irritation? 

Continued mild irritation may excite the functional activity 
of the odontoblasts, thereby producing secondary dentine at 
the expense of the volume of the pulp and its chamber. 

Give the differential diagnosis between pulpitis and 
pericementitis. 

Pulpitis is characterized by throbbing pains of a severe 
type, aggravated in its early stages by contact with hot or cold 
substances. The pain is of a reflected type, due to the fact 
that the pulp has no tactile sense. But very mild response 



206 PATHOLOGY AND THEBAPEUTICS. 

is elicited from percussion. In pericementitis, the tooth is some- 
what elongated by a thickening of the inflamed apical perice- 
mentum, and responds exquisitely upon percussion. 

Describe the treatment for restoring a sound, superior, 
central incisor tooth displaced from its socket by violence. 

The tooth should be placed in a solution of bichloride of 
mercury (1 to 1000) for some minutes, after which the pulp 
cavity should be cleansed and filled. Replace the tooth in 
bichloride solution. Now thoroughly cleanse the tooth socket 
with jets of warm water, removing all clot, and sterilize with 
stimulating antiseptics such as campho-phenique, etc. Great 
care must be observed to keep the mouth in an aseptic condi- 
tion, both during and for a considerable period after the 
operation. The tooth should be removed with sterile forceps 
from the solution, and thrust back into its socket without 
handling. Immobilization may be accomplished by a cap of 
gold securing it to its fellows, and this allowed to remain until 
the tooth has become thoroughly fixed. 



THERAPEUTICS AND MATERIA 
MEDICA. 






What is meant by idiosyncrasy? 

A peculiar or abnormal response to the action of a drug. 

For what conditions in the mouth is sulphuric acid use= 
ful? In what strength and in what manner may it be 
employed? 

In hypersensitive dentine, in simple cavities of decay, to 
open and enlarge minute root canals. In these cases it is em- 
ployed in 50% strength, applied with a gold probe and neu- 
tralized with sodium bicarbonate. In about 10% solutions, 
it may be employed to remove dead bone. 

In what manner may the teeth be best protected from the 
effects of acids administered internally through the mouth? 

Acids should be well diluted, taken through a tube, and an 
antacid at once used to counteract any acidity induced 
through their use. 

What is a counter=irritant? Name two used in the 
mouth. 

A counter-irritant is an agent used to excite vascularity 
where applied, resulting in the relief of pain and vascularity 
in other parts, e. g. capsicum and tincture of iodine. 

What is the dose of tincture of aconite root? 

One half to five minims. 

What is the local action of aconite? 

It acts as a powerful sedative, causing tingling and numb- 

(207) 



208 THERAPEUTICS AND MATERIA MEDICA. 

ness, due to paralysis of terminal nerve filaments. Slightly 
irritating at first. 

What preparation of arsenic is most used in dentistry, 
and what is the local action of this preparation? 

Arsenic Trioxid. 

When brought in contact with the tooth pulp we have con- 
gestion, accompanied by grumbling pain which in a few 
hours becomes acute and throbbing. The blood vessels be- 
come strangulated at the apex of the root, resulting in the 
death of the pulp, with cessation of pain. 

What preparation of iron is particularly injurious to 
the teeth? Why is it injurious? 

Tincture chloride of iron. On account of the free hydro- 
chloric acid it contains. 

Name the drugs that may be combined with arsenic 
for devitalizing a tooth pulp, and state what purposes 
these drugs serve. 

Combined with acetate or sulphate of morphine or hydro- 
chlorate of cocaine, as local anodynes, with an essential oil 
to make a paste and facilitate the application as well as action. 

Name three local anesthetics used in dentistry, and 
state the conditions that call for their application. 

Cocaine hydrochlorate, carbolic acid, tincture of aconite. 
Cocaine hydrochlorate, for hypodermic use in extraction. 
Carbolic acid, where the sensibility of the gum is to be de- 
stroyed to permit of painless incision being made. Tincture 
of aconite, to allay pain by its application to the gum 
tissue in cases of pericementitis. 

What desirable qualities should a disinfectant possess 
for use in a pulp canal? 

Ability to neutralize various products resulting from 
putrefactive processes, and the attribute of penetrability. 

What conditions about the mouth call for the use of 
iodine, and what are its effects? 

In pericementitis, oedema of cheeks or lips, as an aid in 



THERAPEUTICS AND MATERIA MEDIC A. 209 

removing green stain from the surfaces of teeth. Acts as a 
counter-irritant and stimulates absorption of effusions. 

What conditions about the mouth call for the use of 
carbolic acid, and what are its effects? 

Full strength acts as a caustic and may be used to touch 
ulcers. In a 1% or 2% solution, as an antiseptic mouth 
wash in stomatitis. 

How should any injurious results arising from the local 
action of arsenic on the gums be treated? 

By removing all necrotic tissue and touching with an iron 
preparation or tincture of iodine. 

Name two preparations of opium. State the dose of each. 

Tincture of opium or laudanum. Dose, 5 to 15 minims. 
Camphorated tincture of opium or paregoric. Dose, 1 to 
4 fluid drachms. 

Of what drugs are morphine and atropine the alkaloids? 

Opium and belladonna respectively. 
Name a physiologic antidote to cocaine. 

Morphine, whiskey, or nitrite of amyl. 

For what is permanganate of potassium used in 
dentistry? 

Ulcer of the mouth with offensive breath, abscesses, diseases 
of the antrum, necrosis and caries of bone. 

What are the dental uses of the essential oils? 

To obtund hypersensitive dentin, to allay pain in an irri- 
tated pulp, to promote antisepsis in septic root canals and 
cavities. 

Describe the effect of aconite on the heart and name 
two other drugs which have a similar effect. 

Small doses decrease the force of ventricular contraction 
and slow the action of the heart. Large doses cause rapid 
weak action with tendency to stop in diastole. 

Veratrum viride and antimony have a similar effect. 
14 



210 THERAPEUTICS AND MATERIA MEDIC A. 

For what is amyl nitrite used, and how is it admin- 
istered, and what is the dose? 

Stimulant, particularly in cocaine poisoning. Usually ad- 
ministered by inhalation in three to five minim doses. 

What is the danger of using acids in the mouth? What 
precaution should be taken? 

They may cause decalcification of tooth structure. They 
should be followed by antacid mouth washes. 

For what is hydrogen peroxide used? 

To destroy pus, cleanse putrescent pulp canals, and 
whenever a germicide, deodorant or disinfectant is required 
in the mouth. 

Name two escharotics, and state when escharotics should 
be used. 

Silver nitrate, carbolic acid. Escharotics are employed for 
the removal of hypertrophied gum tissue. To obtund hyper- 
sensitive dentin. In the treatment of ulcerative stomatitis, 
and to destroy pulp filaments in roots. 

What precautions should be observed in the adminis= 
tration of the general anesthetics? 

Patients should not eat anything for several hours pre- 
vious, should have bowels thoroughly evacuated, should be 
placed in a horizontal position, all foreign substances re- 
moved from the mouth, clothing loose around the neck and 
chest, a third party present if the patient be a female, 
and the anesthetic selected with reference to any or- 
ganic disease of the patient. Development of dangerous 
symptoms should be watched for, and the anesthetic should 
not be given in an overdose. Resuscitating means should 
be at hand. 

Define hemostatic. Give three examples. 

Hemostatics are agents which stop hemorrhage by coagu- 
lating albumin and contracting the muscle fibres, e. g. tannic 
acid, tincture of iron, and adrenalin chloride. 



THEBAPEUTICS AND MATERIA MEDICA. 211 

Mention a medicine whose local action contracts the 
blood vessels of a part. 

Adrenalin chloride. 

Mention a medicine whose local action dilates the blood 
vessels of the part. 

Aconite. 

Differentiate disinfectant from antiseptic. Give illus- 
trations of each. 

Disinfectants are agents which destroy the germs of dis- 
ease. Antiseptics inhibit the growth of micro-organisms and 
neutralize the toxins, but do not necessarily kill the germs. 

Permanganate of potassium (2% solution), bichloride of 
mercury (1-1000), peroxide of hydrogen are disinfectants. 

Boric acid and the essential oils in mild solution act as 
antiseptics. 

What is the objection to the use of iodoform? Men- 
tion three drugs that may be used in place of iodoform. 

Its very objectionable odor. Iodol, aristol and europhen 
may be used in place of iodoform. 

What is the advantage of the cataphoric as compared 
with the ordinary local application? 

The deeper layers of the dentin and the pulp itself may 
be affected, whereas the ordinary application could not be 
made to affect these. 

What two medicines are particularly useful in cata- 
phoric applications? 

Cocaine hydrochlorate to desensitize dentin and pulp, and 
25% pyrozone for bleaching. 

Mention (a) three remedies for toothache caused by ex- 
posure of the pulp; (b) two remedies for pericementitis. 

(a) Oil of cloves, oil of cinnamon, carbolic acid, (b) 
Tincture of aconite and tincture of iodine. 



212 THERAPEUTICS AND MATERIA MEDIC A. 

Mention (a) a remedy that antagonizes the constitutional 
action of aconite; (b) a remedy that increases the constitu- 
tional action of aconite. 

(a) Opium, (b) Veratrum viride. 

Mention the dose of two of the preparations of opium, 
and the dose of one of the alkaloids of opium. 

Tincture of opium, 5 to 20 minims; powdered opium, y 2 to 
2 grains ; sulphate of morphine, % to % grain. 

Mention the dose of (a) potassium bromide, (b) chloral, 
(c) acetanilid. 

(a) Potassium bromide, 10 to 60 grains; (b) chloral hy- 
drate, 5 to 20 grains; (c) acetanilid, 2 to 10 grains. 

Mention two heart stimulants that act rapidly, and give 
the dose of each. 

Aromatic spirits of ammonia, 30 to 60 minims. 
Ether, 10 to 60 minims. 

State the action of digitalis on (a) the heart, (b) the 
blood vessels, (c) the kidneys. 

(a) Increases the force of the heart contractions; lengthens 
diastole, decreasing the number of beats by stimulation of the 
pneumogastric. 

(b) Raises arterial tension by stimulating vasomotor centre, 
by direct action on the muscular coat and by increasing the 
force of the heart's contraction. 

(c) Dilatation of the renal arteries resulting in an in- 
creased flow of urine, without an irritating effect on the 
renal epithelium. 

What drug is often combined with morphia when given 
hypodermically? Explain. 

Sulphate of atropine. Atropine being the physiological 
antagonist, it diminishes the danger of morphia poisoning. 

Which of the general anesthetics is most depressing to 
(a) the circulation, (b) the respiration? 

Chloroform to the circulation, and ether to the respiration. 



THERAPEUTICS AND MATERIA MEDICA. 213 

Mention two medicines that increase blood pressure. 

Digitalis and strophanthus. 

Distinguish between a stimulant and an irritant. 

A stimulant produces increased functional activity. An 
irritant exceeds the effect of a stimulant and induces venous 
hyperemia, and possibly inflammation. A stimulant acting 
continuously may become an irritant. 

With what class of remedies are the coal tar products 
prescribed for action on the heart? 

With cardiac stimulants. 

What are the dental uses of the alkalies? Mention 
three alkalies. 

To counteract any acid condition in the mouth, as in erosion 
or after acid medicaments. Lime, magnesium, sodium bi- 
carbonate. 

What effect on blood pressure has (a) ether, (b) 
chloroform? 

Ether increases blood pressure. Chloroform lowers blood 
pressure. 

State the dental uses of nitrate of silver. 

In the form of lunar caustic it may be used to destroy 
ulcers in the mouth, or to destroy hypersensitiveness of the 
dentin; in a 5% or even 10% solution, it is employed 
in gangrenous stomatitis. In 50% solutions it has been re- 
commended in the treatment of root canals. 

State with reference to formaldehyde (a) its dental 
uses, (b) the advantages of its use, (c) the objections to 
its use. 

In mild solutions', in association with other agents, as an 
antiseptic mouth wash; in strong solutions, about 5 to 10% 
of formalin, it is used to disinfect instruments. In the treat- 
ment of moist gangrene of the pulp, and wherever a power- 
ful disinfectant is indicated without regard to its intensely 
irritating effect upon mucous surfaces. It is a powerful 



214 THERAPEUTICS AND MATERIA MEDICA. 

disinfectant, and has a hardening effect upon disintegrated 
organic matter. It is intensely irritating to mucous surfaces. 

State the conditions under which it is more advantageous 
to give medicines hypodermically than to administer 
them internally. 

When you wish to produce an immediate effect. When the 
patient cannot swallow, or is in a condition where absorption 
from the stomach would take place slowly. 

Mention one drug that contracts the pupil of the eye; 
one drug that dilates the pupil of the eye. 

Eserine contracts; belladonna dilates. 

State the reasons for or against the use of arsenious 
acid to obtund sensitive dentin. 

It should not be used to obtund hypersensitive dentin, as 
it will devitalize the pulp. 

Of what is each of the following an alkaloid (a) strych- 
nine, (b) atropine, (c) morphine. State the dose of each. 

(a)Nux vomica, (b) belladonna, (c) opium. 

Strychnine, ^ to -^ g r - 5 atropine, T ^ to T ^ gr. ; morphine 
i to i gr. 

What property of tincture of iodine makes it of value in 
pericementitis? 

Its counter-irritating property, and its ability to stimulate 
the lymphatics to absorb inflammatory products. 

In what position should the patient be during the ad- 
ministration of chloroform? Why? 

In the recumbent position, to allow of the easy flow of 
blood to the heart; to counteract the paralyzing influences of 
chloroform upon the circulation. 

Name four properties that a dentifrice should possess. 

Alkaline, antiseptic, sufficiently coarse to be cleansing, and 
agreeable flavor. 



THERAPEUTICS AND MATERIA MEDICA. 215 

What is an antiphlogistic? 

Any therapeutic means of combating the heat of inflamma- 
tory reactions. 

What is an escharotic? 

An agent which devitalizes the tissue upon which it acts, 
producing an eschar or slough. 

Define narcotics and sedatives and give an example of 
each. 

Narcotics are agents that stimulate and stupefy the brain, 
allay pain and induce sleep, as opium. Sedatives are agents 
that depress the nervous centres and allay their irritability 
or excitability, as bromide of potassium. 

Describe what is meant by an aqueous solution, and 
write a prescription, giving example. 

An aqueous solution is a drug held in solution with water. 

R . Acidi tannici gr. x 

Aquse f3J 

Sig. — Use as directed. 
What is arsenous acid? Give medical properties and 
special dental use and antidote. 

Trioxide of arsenic. Internally, in small doses, it acts as an 
alterative tonic, promoting appetite and digestion, stimulating 
respiration and circulation, and increasing mental faculties. 
In dentistry, it is employed to devitalize the pulp. The anti- 
dote in cases of poisoning is freshly prepared hydrated ferric 
oxide. 

Give the medical properties and dose; when indicated in 
dental practice, and how used; toxic effects, if any; anti» 
dotal treatment of each of the following: — Aconite, 
quinine, napthol, creasote, oil of cloves. 

Aconite locally paralyzes the terminal sensory filaments, 
causing numbness and loss of sensibility. Internally, in small 
doses it depresses respiration and circulation, and in large 
doses it paralyzes the heart's, action. In dental practice it 
may be used locally to stop pain from an irritated pulp, or as 



216 THERAPEUTICS AND MATERIA MEDICA. 

a sedative applied over the gum in pericementitis. Opium, 
or any cardiac stimulant, together with artificial respiration, 
is used in cases of poisoning. The dose is 1 to 3 minims of 
the tincture. 

Quinine is a tonic, antiseptic, antipyretic and antiperiodic. 
It interferes with the functions of the red blood corpuscles 
and arrests the movements of the white. In small doses it 
stimulates the brain; in large doses, it produces cerebral 
anemia, ringing in the ears, headache, delirium and coma. 
The tonic dose is 2 grs., the antipyretic 5- 1 ** grs., and the anti- 
periodic 10-20 grs. Morphine antagonizes its cerebral action, 
atropine its cardiac and antipyretic effects. Its use in den- 
tistry is indicated when a patient gives evidence of septic 
fever through absorption of septic products in cases of acute 
septic pericementitis or alveolar abscess; in combination with 
acetanilid and salol, two grains of the sulphate of quinine 
given every two or three hours will have a controlling effect. 

Naphthol is a derivative of naphthalin, and has marked 
antiseptic properties. In dentistry it is used as hydro- 
naphthol, a powerful antiseptic in a 1 to 200 solution. 

Creasote locally acts as an anodyne. Internally in small 
doses, its action is similar to carbolic acid. It is eliminated 
by the bronchial mucous membrane, which it stimulates, pro- 
ducing the effects of an expectorant. It is sedative to the 
mucous membrane of the stomach. In dentistry, it is indi- 
cated wherever carbolic acid is used, although the latter is 
favored because it has not the intensely disagreeable odor of 
creasote. Dose. 1 to 3 minims in oil. 

Oil of cloves belongs to a group of aromatic oils that possess 
many properties in general. They are antiseptics, stimu- 
lants, and local anesthetics. Dose, 1 to 5 minims. In den- 
tistry, they are used generally to allay pain in an aching pulp. 

Name three drugs useful in the treatment of empyema 
of the antrum, and write a prescription containing one 
such drug in solution. 

Hydrogen dioxide, chloride of zinc, hydronaphthol. 



THERAPEUTICS AND MATERIA MEDIC A. 217 

J*. Hydronaphthol 3 j 

Alcohol f £ j 

Sig. — Teaspoonful in a wineglass of water. 

Name three heart stimulants administered hypodermi- 
cally in the order of their rapidity of action. State dose 
of each. 

Alcohol, strychnine, digitalis. 
Alcohol (whiskey), 30 to 60 minims. 
Strychnia sulphate, ^ to ^ gr. 
Digitalis (tincture), 5 to 10 minims. 

Define styptic and irritant, and give an example of each. 

A styptic is an agent applied locally to check hemorrhage, 
like tannic acid. An irritant is an agent capable of drawing 
an excess of blood to the part upon which it is acting, like 
iodine. 

Name two drugs that are physiologically incompatible, 
and two that are chemically incompatible. 

Aconite and morphine; belladonna and opium, are phy- 
siologically incompatible. Tannic acid and iron; sulphuric 
acid and lime, are chemically incompatible. 

Give the dental uses of oil of cinnamon, silver nitrate, 
aconite, capsicum. 

Oil of cinnamon is used to allay pain in an irritated pulp, 
or as an antiseptic application in root canals. Silver nitrate 
may be used in the form of lunar caustic to touch ulcers ap- 
pearing in the mouth, or in full strength to obtund hyper- 
sensitive dentin. It has also been recommended, in 50% 
solution, in the treatment of pulpless canals. Tincture of 
aconite is used as a sedative application in pericementitis; 
also, to control an aching pulp, and as an ingredient of oint- 
ments for neuralgia. Capsicum is used as a counter-irritant 
in pericementitis, and as a stimulating ingredient in mouth 
washes. 



218 THERAPEUTICS AND MATERIA MEDIC A. 

How is the muscular system affected in complete anes- 
thesia under ether and under nitrous oxide? 

Under ether the muscles are relaxed. Under nitrous oxide 
the muscles are contracted. 

What are the advantages and disadvantages in the use 
of chloroform as an anesthetic in tooth extraction? 

The anesthesia resulting from inhalations of chloroform is 
prolonged, affording free opportunity for the removal of any 
number of teeth. The disadvantages are decided. The up- 
right position is against the patient; and, furthermore, fail- 
ure of the heart's action is apt to result in consequence of the 
irritation of the pneumogastric induced through irritation of 
the fifth pair of nerves in the extraction. 

What is ethyl chloride? Describe method of producing 
local anesthesia by its use, and state precautions to be 
observed. 

Ethyl chloride is a volatile colorless liquid with a boiling- 
point of about 60° F. When a spray is directed against tissue 
it acts as a freezing agent by its very rapid volatilization. 
The tissue not to be affected should be protected against the 
spray. By the use of cold applications the tissue may be pre- 
vented from too quickly returning to a normal state, and thus 
lessen the incident pain which is usually felt after the use 
of chloride of ethyl. 

Give the precautions to be observed before and during 
the administration of nitrous oxide. 

The patient should be examined as to physical condition, 
and also as to what teeth or roots are to be extracted, so that 
no time is lost later. Care should be taken that sufficient 
nitrous oxide is at hand for the operation, and a third party 
should be present. The jaws should be kept separated. Dur- 
ing the administration, the respiration should be carefully 
watched. Interference with respiration is the chief source 
of danger. As soon as the anesthetic state ; is induced, 
further administration should at once cease. 



THERAPEUTICS AND MATERIA MEDIC A. 219 

Describe fully two methods for producing local anes- 
thesia. 

Hypodermically, with a 1% or 2% solution of cocaine 
hydrochlorate, injecting about 20 minims of the 1% or 10 
minims of the 2% solution about the alveolar tissue; or by 
means of a spray of ethyl chloride, protecting the tissues 
not to be affected. The spray is directed until the tissues 
whiten. It is better not to allow a too rapid return 
to a normal condition of the anesthetized parts. This may 
be produced by directing the patient to hold cold water in 
the mouth. 

Describe methods of procedure and precautions neces- 
sary in hypodermic injections for producing local anes- 
thesia. 

The parts to be operated upon should be treated antisepti- 
eally, so that no adherent septic matter is carried into the 
subtissues. The needle and solution should be perfectly 
aseptic. Care should be taken not to penetrate a blood vessel. 
After injection the fluid should not be allowed to escape. 
The proper quantity and no more should be injected. 

How is anesthesia modified by age, sex and tem- 
perament? 

In children we find a ready response to the inhalation of 
anesthetics. When ether is used, a hypersensitive mucous 
surface in the pharynx and larynx induces coughing; in the 
aged, chronic bronchial irritation is apt to produce the same 
result. Women are apt to give manifestations of hysterical 
tendencies. Sex and temperament may influence the amount 
necessary to induce anesthesia. The stage of excitement may 
be prolonged in hysterical subjects, and also in those of 
bilious attributes. 

What anesthetic do you prefer, and for what reason? 

For the extraction of teeth and minor operations in the 
mouth that require little time for their execution, nitrous 
oxide is the safest anesthetic we have at the present time. 



220 THERAPEUTICS AND MATERIA MEDIC A. 

From a most extended experience during which hundreds of 
thousands of patients have been placed under its influence, 
the death rate is practically nil. 

Mention the differences between cocaine and eucaine. 

Cocaine is an alkaloid, soluble to the extent of over 30% 
in water, decomposes upon boiling, and frequently is fol- 
lowed by poisonous symptoms. Eucaine is synthetically pre- 
pared; is soluble to the extent of about 4% in water, does 
not decompose when subjected to heat, and its use is not so 
frequently followed by dangerous symptoms. 

At what period in nitrous oxide anesthesia may you 
have failure in circulation? 

After the anesthetic stage, owing to anemia of the brain. 

What causes the darkened appearance of the patient 
under nitrous oxide, and state in what manner this may 
be lessened? 

The accumulation of carbon dioxide. Giving oxygen in 
combination with nitrous oxide will considerably lessen the 
bluish appearance of the countenance. 

What is liquid nitrous oxide? 

The gas nitrous oxide liquefies when subjected to a pressure 
of about 700 pounds at a temperature of about 45° F. 

What is the appearance of the face under ether an- 
esthesia? 

Generally flushed. 

What appliances should be at hand and in readiness 
when anesthetics are used? 

Hypodermic syringe, with various respiratory and circula- 
tory stimulants. Also the facilities for performing artificial 
respiration. 

How is bromide of ethyl administered, and what is 
its action? 

The quantity to be administered is poured out upon a 
towel (about 2 drachms) and inhaled by the patient. Bro- 



THERAPEUTICS AND MATERIA MEDICA. 221 

mide of ethyl resembles chloroform in its action upon the 
heart. It interferes with the function of the red corpuscles, 
and affects consciousness last; in many cases patients are 
conscious and yet not perceptive of any pain. The anes- 
thesia generally lasts about five minutes. 

What strength of solution of cocaine would you employ 
for hypodermic use, and how much of the solution would 
you use? 

Generally 1% or 2% solution is employed. 20 minims of 
the 1%, or about 10 minims of the 2% solution may be 
injected. 

Give the antidote of the following drugs, (a) iodine, 
(b) bichloride of mercury, (c) arsenic, (d) phosphorus. 

(a) Starch, (b) albumin, (c) hydrated ferric oxide (freshly 
prepared), (d) turpentine. 

Mention two drugs insoluble in water. 

Bismuth subnitrate and mercurous chloride. 

What alkaloids are found in opium? What is its active 
principle? 

Morphine, codeine, narcotine, thebaine. 

The most important active principle is morphine. 

What is meant by a mydriatic? Name one. 

A mydriatic is an agent which causes dilatation of the pupil 
of the eye, e. g. belladonna. 

What is meant by a synergist? Name the synergists 
of aconite. 

A synergist signifies an aid. Veratrum viride, tartar emetic 
or bromide of potassium act as synergists to aconite. 

What is a cathartic, and how are cathartics divided? 

Cathartics are agents which produce evacuation of the in- 
testinal tract. They may be arranged according to the 
severity of the effect. Laxatives are the mildest, purgatives 
are more severe, and drastics most severe in their action. 



222 THERAPEUTICS AND MATERIA MEDIC A. 

Give the treatment of poisoning from cocaine. 

Fresh air, inhalations of nitrite of amyl or ammonia. 
Alcohol, (brandy or whiskey), aromatic spirits of ammonia, 
strychnine, digitalis and atropine, hypodermically or by the 
mouth. External heat. 

State the local action of cocaine on the blood vessels. 

Cocaine applied to a mucous membrane or injected under 
the skin causes the blood vessels of the part to contract. As 
the effect passes off, the reaction results in dilatation. 

Name three mineral acids employed in dentistry and 
give their properties and uses of each. 

Hydrochloric acid. — The strong acid is a powerful caustic 
and escharotic; also disinfectant and fumigant. The dilute 
acid is tonic, refrigerant and astringent. 

The strong acid is employed as a local application in 
gangrenous stomatitis, or cancrum oris, for arresting the 
ulcerative process. Combined with equal parts of glycerine 
it is useful in inflammation and ulceration of the oral mucous 
membrane; also in cases of sloughing. In aphthous ulcera- 
tion of the mouths of children, it is often useful. 

Nitric Acid. — Pure nitric acid is a powerful caustic and 
escharotic. The dilute acid is an antalkaline, alterative, tonic 
and refrigerant. 

The strong acid, when mixed with two parts of hydro- 
chloric acid, is a solvent for gold. It is employed as a caustic 
in cancrum oris; also for malignant ulcers of the mouth 
and for devitalizing pulp of teeth when nearly exposed by 
mechanical abrasion. 

Sulphuric acid. — The strong acid is a powerful escharotic, 
the dilute acid is refrigerant, astringent and tonic. The 
concentrated sulphuric acid is used as a caustic in malignant 
ulcers, cancrum oris and gangrene in the form of a paste, 
made by mixing it with powdered sulphate of zinc. It is also 
used to cleanse metal plates. The dilute acid or the aromatic 
sulphuric acid which is more agreeable, is used in pyorrhoea 
alveolaris, and in caries and necrosis of the maxillary bones, 



THERAPEUTICS AND MATERIA MEDIC A. 223 

as an injection or lotion. It is also employed in cases of re- 
cession of the gums and absorption of the processes. It is 
valuable in alveolar abscesses as an injection. It is employed 
in stomatitis and ulcers of the mouth. 

Mention (a) two heart stimulants, (b) two heart seda- 
tives. State the dose of each. 

(a) Aromatic Spirits of Ammonia, 20 minims to 1 drachm. 
Whiskey, 2 drachms to 1 ounce. 

(b) Tincture of aconite, 1 to 5 minims. 
Tincture of veratrum viride, 3 to 30 minims. 

Mention three medicines used to produce emesis and 
state how each is administered. 

Sulphate of zinc, 10-30 grs. by mouth. 

Mustard 1 to 2 drs. by mouth. 

Apomorphine hydrochlorate, ^-J- gr. hypodermically. 

Mention three medicines used to produce diaphoresis. 

Pilocarpine, tartar emetic and Dover's powder. 
What is the local action of chloroform? 

Placed on the skin and allowed to evaporate it produces a 
sensation of cold. If the vapor be confined it causes irrita- 
tion with redness and even vesication accompanied by a sen- 
sation of heat, followed by numbness and a decreased sensa- 
tion of the part. 

Define materia medica, therapeutics. 

Materia medica treats of the source of drugs, their physi- 
cal and chemical properties and may also include their phy- 
siological action. 

Therapeutics treats of the application of remedial agents 
to disease. 

In what ways may medicines enter the system? 

Mouth, rectum, respiratory tract, absorbed through the 
skin and injected under the skin. 



s 



224 THERAPEUTICS AND MATERIA MED1CA. 

Name two drugs whose poisonous action is markedly 
manifest in the mouth. Give the distinguishing char- 
acteristics of the effects of these drugs. 

Iodides and mercury. 

Iodism is manifest by swelling and redness of the gums, 
fauces, hard and soft palate, foulness of the tongue, fetid 
breath, and increase of mucus in the mouth; also headache, 
coryza and increased bronchial secretion. Mercury may in- 
crease the salivary flow to several pints per day. At first the 
secretion is thick but later becomes thin. Fetid breath, sore 
gums, may go on to ulceration of the mouth and cheeks. 
Low fever. 

Which of the vital organs fails first in collapse from 
(a) ether, (b) chloroform? 

(a) Kills by paralysis of respiratory center, (b) usually 
the heart, but may be respiratory center. 

Name two medicines that decrease blood pressure. 

Tartar emetic and tincture of aconite. 

Describe the method of administering a medicine by 
which its quickest action is obtained. 

The medicine in solution is placed in a hypodermic syringe 
(the syringe and solution being as near aseptic as possible). 
The air is expelled while the needle points upward, sterilize 
the skin and inject contents into the cellular tissue. 

Define diuretic, diaphoretic, expectorant. 

Diuretics are agents which increase the flow of urine. 
Diaphoretics increase the perspiration. Expectorants in- 
crease and modify the secretion of the bronchial mucous 
membrane. 

Differentiate a tonic and a stimulant. 

Tonics promote secretion and give tone to the system. 
Stimulants increase the function of the part or organ. 

Mention two medicines that may be used as cauteries. 

Nitrate of silver and carbolic acid. 



THERAPEUTICS AND MATERIA MEDIC A. 225 
State the treatment of carbolic acid poisoning. 

Administer a soluble sulphate (sodium or magnesium) and 
follow by albumin and mucilaginous drinks. Wash out the 
stomach. Combat collapse by external heat and with hypo- 
dermic injections of strychnine and atropine. 

What is an emetic? 

Emetics are agents which excite vomiting either by local 
or central action. 

Mention two drugs that reduce fever. 

Acetanilid. Quinine. 

Describe the symptoms of cocaine poisoning. 

A rapid, feeble and irregular pulse, with shallow and lab- 
ored respiration, clammy skin, dilated pupils, delirium and 
hallucinations. May have clonic convulsions and increased 
temperature. 

What restoratives are most desirable in case of threat- 
ened collapse during the administration of (a) Nitrous 
Oxide, (b) Ether, (c) Chloroform. 

(a) Amyl nitrite, oxygen, atropine. 

(b) Ammonia, oxygen, strychnine, atropine and faradic 
current. 

(c) Ammonia, strychnine and digitalis. 

What is the antidote for opium? ]/ 

Potassium permanganate (chemical). Atropine (physio- 
logical) . 

What is the dose of bichloride of mercury? 

fa t0 tV g r - 

Mention two purposes for which medicines may be 
applied cataphorically in dentistry. 

Por painless tooth extraction, and to antisepticize pulp 
canals. 

15 



V 



226 THERAPEUTICS AND MATERIA MEDICA. 

What medicines are indicated and about how long 
should they be applied cataphorically for the purposes 
mentioned in the preceding question. 

(a) Cocaine, (b) Silver Nitrate, 8 to 20 minutes. 

Mention three saline cathartics and state the dose of 
each. 

Sulphate of magnesia (Epsom salt), 1 drachm to iy 2 ounces. 
Tartrate of Potassium and Sodium (Rochelle salt), 1 drachm 
to 1 ounce. 

Solution of Citrate of Magnesia, 12 ounces. 

Mention three good counter=irritants. 

Cantharides, tr. of iodine, and mustard. 

Define chemical antidote for a poison, physiological anti= 
dote for a poison. 

By chemical antidote is meant some substance which com- 
bines chemically with the poison, producing an inert or in- 
soluble compound. By physiological antidote is meant a sub- 
stance which is opposed to the poison in its action on- the 
economy. 

State three properties of carbolic acid. 

Local anesthetic, caustic and antiseptic. 
Name the antacids valuable for use in the mouth. 
Sodium bicarbonate, lime water, chalk and charcoal. 
What is the chief use of capsicum in dentistry? 

As tincture or plaster in periodontitis. 

What is meant by chemical and physiological incom= 
patibility of medicines? 

Agents are said to be chemically incompatible when their 
mixture results in the decomposition of one or more of the 
ingredients. 

Physiological incompatibility is where one drug produces 
effects upon the system opposite to the action of some other 
drug, like aconite and opium. 






THERAPEUTICS AND MATERIA MEDIC A. 227 

Give the physiological action of belladonna. 

Belladonna is an anodyne, an anti-spasmodic, a mydriatic, 
an irritant narcotic ; in small doses a respiratory, cardiac, and 
spinal stimulant; in large doses a paralyzer of the secretory 
and motor nerve endings, and a stimulant of the sympathetic 
system. It produces dryness of the mucous membranes of the 
nose, mouth, throat and larynx ; and at first lessens the gastric 
and intestinal secretions, but soon reproduces them in large 
quantity. The heart-rate is at first slowed, but soon becomes 
vigorous and rapid. 

Give the mouth signs of mercurial poisoning. 

Hyperemic mucous surface, teeth tender upon pressure and 
loose, increased flow of saliva, swollen tongue, and metallic 
taste. 

How should the administration of chloroform differ 
from that of ether? 

Chloroform should be administered a few drops at a time 
and the vapor allowed to mix freely with air, while ether is 
administered in larger quantities and only a small amount of 
air allowed to mix with the vapor. 

State the objection to the use of iron salts, as styptics. 

The clot which is formed is soluble in the fluids of the 
mouth, frequently resulting in secondary hemorrhage. Iron 
solutions used are also strongly acid. 

Mention, with doses, three coaNtar preparations, useful 
in the treatment of neuralgia. 

Acetanilid, 2 to 10 grs. ; phenacetin, 2 to 10 grains ; anti- 
pyrine, 5 to 10 grs. 

Differentiate poisoning by atropine and poisoning by 
strychnine. 

In atropine poisoning we have motor paralysis, delirium 
and death. In strychnine poisoning we have convulsive ac- 
tion of the muscles with consciousness. Death follows from 
exhaustion and asphyxia. 



228 THERAPEUTICS AND MATERIA MEDIC A. 

Write a prescription for an antiseptic mouth wash. 

R. Acidi carbolici (95%) mm 

Aquae q. s. f | v 

Sig. — Use as mouth wash. 
What is meant by the active principles of a drug? Give 
an example. 

The extractive substance which gives the drug its medicinal 
properties. Quinine is an active principle of cinchona bark. 

Mention three alteratives. 

Arsenic, mercury and iodine. 

Give the physiological action of ergot. 

Externally it acts as a siight astringent on the broken skin 
or mucous membrane. 

G-astro-intestinal tract. — Disagreeable taste and may pro- 
duce nausea and vomiting. 

Circulation. — Heart-beat becomes slow and increased in 
force. It stimulates the vaso-motor centre and unstriped mus- 
cular fibres of arteries/ raising blood-pressure. 

Uterus. — It stimulates the contraction of the parturient 
uterus, increasing the force and frequency. There is a marked 
decrease in the blood supply of the nonparturient uterus. 

Nervous system. — It causes anaemia of the centres, par- 
ticularly in the spinal cord. 

Give the physiological action of digitalis. 

Gastro-intestinal tract. — Digitalis may cause nausea, vomit- 
ing and diarrhoea. 

Circulation. — Decreases the number of heart beats, length- 
ening diastole ( stimulation of inhibitory fibres of vagus) . It 
increases the force of the contractions (intrinsic ganglia). 
Arterial tension rises from increased cardiac force, excita- 
tion of vaso-motor centre, and direct action on the muscular 
coats of the arteries. By relaxation of renal arteries 
it increases flow of urine. Later the heart becomes weak 
and irregular, beating with increased frequency. Large 
doses decrease abnormal temperature. It may cause head- 
ache, vertigo or delirium. It also stimulates the uterine 
contractions. 



THERAPEUTICS AND MATERIA MEDICA. 229 



i^ 



Give the physiological action of nux vomica. 

Gastro-intestinal tract. — Small doses act as a bitter tonic, 
increasing appetite, secretion and digestion. It increases 
the muscular tone of the stomach and peristalsis is also 
increased. 

Circulation. — Cardiac centre, vaso-motor centre and cardiac 
ganglia are stimulated, raising arterial tension, increasing the 
force of heart action but slowing its beat. The respiratory 
centre is stimulated, the pupils dilated, the contractile power 
of the bladder is stimulated, the reflex activity of the spinal 
cord is increased. It also acts as an aphrodisiac. 

Give the physiological action Of opium. 

Externally it is slightly sedative. 

Stomach. — It decreases sensation, secretion and peristalsis, 
reducing hunger and pain. Continued use deranges digestion. 

Intestines. — Sedative action, relieving pain, secretion de- 
creased and peristalsis is decreased by stimulation of the 
splanchnics (inhibitory nerves). Large doses may cause 
diarrhoea leading to paralysis of the splanchnics. Bile and 
pancreatic juice are decreased. 

Nervous System. — The convolutions of the brain are briefly 
excited, then depressed by direct action on nerve cells (possi- 
bly by causing anemia). 

Stage of Excitement. — Exaltation of feelings, happiness, 
brilliancy of imagination, increase of intellectual power and 
mental vigor. Imagination becomes extravagant, dreams of 
grotesque and impossible things. Sensory and perceptive 
centres become depressed, stupor and sleep. Pupils contracted. 

Write a complete prescription for a four ounce aqueous 
solution containing three drugs, (b) State the amount of 
each drug contained in a teaspoonful of the solution. 

For John Smith. 

R . Potassii bromidi gr. clx 

Chloralis gr. lxiv 

Tincturse digitalis m. xlviii 

Aquae, q. s. ad f 5 iv 

M. Sig. — Teaspoonful in water every hour until relieved. 
10-29-' 04. OR. I>. . 



230 THERAPEUTICS AND MATERIA MEDIC A. 

(b) Potassium bromide, 5grs. ; chloral, 2grs. ; tincture of 
digitalis, iy 2 minims. 

Under what conditions is ether contra-indicated as an 
anesthetic? 

In acute inflammatory infections of the respiratory tract, 
advanced arteriosclerosis, severe nephritis, especially when 
associated with cardiovascular lesions and anemia when the 
hemoglobin is less than 30%. Diabetes mellitus, especially 
when well established and associated with acetonuria 
(Stevens). 

Name the most common aftereffects of the administra- 
tion of ether. 

Nausea and vomiting. 

Name the accidents that may happen during the admin- 
istration of ether, and give the treatment in each case. 

In the early part of the administration of ether we may 
have failure of respiration, which is due to reflex spasm of 
the laryngeal muscles excited by the ether. By giving more 
air with the ether we can correct this trouble. 

Embarrassed respiration may be due to the accumulation 
of mucus in the upper air passages. In this condition we 
simply turn the head to one side. 

Respiratory failure may be caused by the action of the 
ether on the respiratory centre. In this case we withdraw 
the ether; push the jaw forward by pressing on its angles, 
draw the tongue forward by means of a tenaculum or forceps 
and make rhythmic traction of the tongue. Pour ether on 
the abdomen or chest in order to stimulate inspiration by 
reflex action, give strychnine and atropin hypodermically. 
Practice artificial respiration. 

When is chloroform preferred to ether as an anaesthetic? 

In acute inflammation of the bronchi or lungs, aneurism, 
atheroma and nephritis. 



THERAPEUTICS AND MATERIA MED1CA. 231 

Give the signs of danger in chloroform anaesthesia and 
tell what should be done. 

Lividity of the face, irregular or stertorous breathing or 
feebleness of the pulse. Withdraw the anesthetic, lower the 
head, use artificial respiration and give a hypodermic in- 
jection of strychnine, digitalis, or ammonia. 

What are topical remedies? (b) Mention two classes. 
(c) Give two examples of each. 

Topical remedies are those which are applied locally. 

(b) Plasters and liniments. 

(c) Belladonna plaster and capsicum plaster — turpentine 
liniment and chloroform liniment. 

What systemic conditions contra=indicate the use of 
nitrous oxide gas? (b) State why? 

Atheromatous vessels, fatty heart and pulmonary em- 
physema. (Burchard.) 

(b) Nitrous oxide gas increases blood pressure and in 
atheromatous degeneration of the arteries this may result in 
rupture of these vessels and if in the brain, apoplexy or early 
death may ensue. 

In fatty heart the muscles are weakened, and on account of 
the increased resistance in the blood-vessels there may be 
sudden dilatation of this organ. 

In pulmonary emphysema the danger is in the engorgement 
of the blood vessels of the lungs which causes an increased 
resistance to the right heart, which may result in the sudden 
dilatation of this organ, or there may be pulmonary edema or 
hemorrhage. 

Give the indications for the use in producing sleep of 
(a) morphine, (b) chloral, (c) potassium bromide. 

(a) Morphine is used when sleeplessness is due to pain. 

(b) Chloral is indicated when sleeplessness is due to mental 
overwork and where a more powerful hypnotic than potassium 
bromide is required. If the heart or stomach are in bad 
condition it should not be given. 



232 THERAPEUTICS AND MATERIA MEDICA. 

(c) Potassium bromide is given when insomnia is caused 
by cerebral excitement, nervous excitement (especially when 
connected with the genital function) and motor activity. Ac- 
cording to Wood it is contra-indicated by an excessive irri- 
tability of the gastro-intestinal mucous membrane and great 
exhaustion. 

What is an analgesic? Mention three. 

An analgesic or anodyne is an agent which relieves pain. 
This may be accomplished by local or central action. Opium, 
cocaine and chloroform are examples. 

Why is the use of ether as an anaesthetic contra=indi- 
cated in diseases of the lungs and kidneys? 

Because it is eliminated by the lungs and kidneys, and on 
account of its irritating qualities it would aggravate the 
diseased condition. 

Describe the three stages of chloroform narcosis. 

1st stage. This stage is very short and the symptoms are 
very similar to those of alcoholic intoxication. Conscious- 
ness is not lost but the sensibility is generally dulled, but 
rarely altogether abolished. 

2d stage. This is the stage of anesthesia, consciousness and 
sensibility are abolished, the muscles are relaxed and the 
patient is quiet. The pulse is generally normal in frequency, 
but somewhat weakened. 

3d. stage. This stage is one of profound narcosis with ster- 
torous breathing, intense muscular relaxation, abolition of the 
ordinary reflexes and fall of bodily temperature. Pulse is 
weak and rapid. 

Give the contraindications to the use of anaesthetics. 

Organic brain disease, including tumors, atheromatous con- 
ditions of the blood vessels, organic affections of the heart, 
lungs and kidneys (Wood). Some authorities add diabetes 
mellitus, chronic alchoholism and enlarged tonsils. 



THERAPEUTICS AND MATERIA MEDICA. 233 

Describe the three stages of anesthesia under ether. 

1st stage. Burning in the fauces, feeling of strangulation, 
sense of exhilaration, lightness in the head with a buzzing or 
roaring in the ears. These symptoms are soon followed by a 
feeling that the surroundings of the patient are at a distance, 
which fades into semi-unconsciousness with visions and illu- 
sions. Patients may laugh, shout, weep, fight or pray. 

2d. stage. This stage begins with a complete loss of con- 
sciousness. Muscular rigidity soon passes off and the patient 
is quiet. Respiration is slow and regular. 

3d stage. Same as the third stage under chloroform 
narcosis. 

Name the ingredients of a desirable dentifrice and 
specify the properties that make each of these ingredients 
desirable. 

Precipitated chalk gives body, is abrasive and also antacid. 
Orris root gives flavor and masks the soap. 
Powdered soap is antiseptic a,nd removes fatty film from 
the teeth. 

Saccharine sweetens, and disguises earthy taste of chalk. 
Menthol is strongly antiseptic and cooling. 

What is meant by cataphoric application of a remedy? 

By cataphoric application of a remedy is meant the in- 
filtrating of the tissue with some drug by electrical osmosis. 

Differentiate a decoction, an infusion and a tincture. 

Decoctions are solutions of the active constituents of drugs 
obtained by boiling them with water. 

Infusions are aqueous solutions of the medicinal consti- 
tuents of plants, obtained by infusing the drug with hot water, 
the drug not being subjected to boiling. 

Tinctures are solutions of non-volatile substances in alcohol. 

Differentiate fixed oils and volatile oils and give three 
examples of each. 

Fixed or fatty oils are permanent liquids, or at certain tem- 



) X 



234 THERAPEUTICS AND MATERIA MEDICA. 

peratures solid substances, not volatilized by heat, and leave 
greasy stain on paper. They consist mainly of varying pro- 
portions of olein, palmitin, stearin. 

Castor, linseed and olive oils belong to this class. 

Volatile or essential oils, so called' because they usually rep- 
resent the odorous principles of plants, are entirely dissi- 
pated by exposure to the air or heat. They leave no stain 
on paper, have hot, pungent taste, but when diluted are agree- 
ably aromatic. They consist of two principles — a solid 
stearopten, and a liquid eleopten portion. They are limpid 
fluids at ordinary temperatures. Oils of cloves, winter green 
and cinnamon belong to this class. 

What is hydrogen dioxide? Give its formula and dental 
uses? 

Hydrogen Dioxide (U. S. P.) is a slightly acid, aqueous 
solution containing, when freshly prepared, about 3% by 
weight of the pure dioxide, corresponding to about 10% of 
available oxygen. Formula is H 2 2 . Its dental uses are to 
destroy pus and whenever a non-toxic disinfectant is indicated. 

What is iodoform? Give a solvent and state dental uses. 

Iodoform occurs as small, lemon-yellow crystals of a very 
persistent, disagreeable odor, made from the action of iodine 
on alcohol with potassium hydrate or carbonate. It is almost 
insoluble in water, very soluble in alcohol, ether, chloroform, 
fixed and volatile oils. In dentistry it is employed as a 
root canal dressing. 

What is formaldehyde? State the dental uses and the 
strength of solution that should be used for each purpose. 

Formaldehyde is a colorless irritating gas, produced by 
the oxidation of methyl- alcohol. It is very soluble in water 
and alcohol, and occurs commercially as a 40% aqueous solu- 
tion. It is used in dentistry in mouth washes as an antiseptic 
in % to 1% solution. 



THERAPEUTICS AND MATERIA MEDICA. 235 

Write two complete prescriptions, one containing a 
drug in aqueous solution and the other containing a drug 
insoluble in water, also in solution. 

For Miss Jones. 

Be . Plumbi acetatis gr. v 

Aquse dist f^j 

M. Sig. — Use as directed. 

J. V. Doe. 

For Miss . 

i£ . Hydro-naphthol 3J 

Alcohol f 3 j 

M. Sig. — Teaspoonful in wineglass of water, as a wash. 

J. V. Doe. 

What are fluid extracts? 

They are liquid, alcoholic preparations of drugs, permanent 
and concentrated to such a strength that 1 c. c. represents 
the equivalent of one gram of the drug. 

What is bromide of ethyl? 

Bromide of ethyl is a colorless, volatile liquid with ethereal 
odor. Made by distilling a mixture of potassium bromide, al- 
cohol and sulphuric acid and purifying the distillate. 

Distinguish between narcotics and hypnotics. 

Narcotics are drugs, all more or less poisonous, which de- 
press the higher functions, lessen, and in large doses abolish 
sensibility to pain and cause sleep, which is usually followed 
by unpleasant symptoms. 

Hypnotics induce refreshing sleep with no untoward after 
effects. They are cerebral sedatives. 

Write a prescription for a wash for a purulent antrum, 
using no proprietary terms. 

B . Sodium bicarbonate gr. xxx 

Thymol gr. v 

Alcohol f o iv 

Glycerine f 3 i 

Water, q s f £ iv 

M. Sig. — To be used as directed. 



236 THERAPEUTICS AND MATERIA MEDIC A. 

Mention two heart stimulants administered by inhala- 
tion and state under what circumstances they are par- 
ticularly useful. 

Amyl-nitrite — in chloroform anesthesia should cardiac fail- 
ure occur. 

Ammonia — in syncope from any cause. 

What physical states of medicine are most suitable 
for different methods of administration? 

By mouth — solution, pill, powder or capsule. 

By inunction — liniment, ointment or plaster. 

By inhalation — vapor. 

By rectum — solution or suppository. 

By hypodermic injection — always in solution. 

Write a prescription for an astringent mouth wash, 
using no proprietary terms. 

R . Sodium bicarbonate <■ gr. xxx 

Tincture of iodine ■ • • • • f 3 j 

Tannic acid gr. xxx 

Water f Jf vi 

Sig. — To be used as a mouth wash as directed. 

Mention three disinfectants suitable for use in putres- 
cent pulp canals. 

Formaldehyde. Carbolic acid. Bichloride of mercury. 

Mention a chemical antidote for carbolic acid. 

Magnesium sulphate. 

Define germicide, deodorant. 

Germicides are agents that destroy germs. 
Deodorants cover or destroy disagreeable odors. 

How do drugs produce emesis? 

Drugs produce emesis by acting on the stomach directly, 
afferent impulses stimulating the vomiting centre in the 
medulla, and by stimulation of the centre in the medulla 
itself. 



THEBAPEVTICS AND MATERIA MEDICA. 237 

Write a complete prescription calling for three drugs 
which may be suitably combined. 

R . Acetanilid 3 j 

Sodium bicarbonate 

Caffeine aa gr. xv. 

M. et ft. chartae no. xii. 

Sig. — Take one every two hours. 

Define antipyretics. Mention three. 

Antipyretics are drugs which reduce temperature when ab- 
normally high by retarding oxidation, by increasing heat dis- 
sipation, or by acting either on the heat-producing center of 
the brain or on the circulation. 

Acetanilid. Aconite. Quinine. 

Mention, with the dose of each (a) saline cathartic, 
(b) laxative cathartic, (c) cholagogue cathartic. 

(a) Magnesium sulphate, dose 2 to 8 drams. 

(b) Cascara sagrada (fluid extract) 15 to 60 minims. 

(c) Calomel in large doses, 2 to 10 grs. 

Mention three medicines used as styptics. 

Alum. Tannic acid. Solution of ferric subsulphate. 

Mention a medicine that stimulates absorption by the 
lymphatics. 

Potassium iodide. 

Mention three essential oils and state their dental uses. 

Oil of cinnamon — antiseptic root canal dressing. 
Oil of cloves — to relieve toothache. 

Oil of wintergreen — for its agreeable taste and antiseptic 
qualities in dentifrices. 

Mention two agents used in bleaching teeth and de- 
scribe the method of their application. 

Sodium dioxide placed in moist cavity, liberates nascent 
oxygen, thereby bleaching the dental tissues. Twenty-five 
per cent, pyrozone has similar action. 



\ 






238 THERAPEUTICS AND MATERIA MEDICA. 

What remedies, general or local, aside from operative 
procedure, are useful for the relief of toothache? (a) 
when the pulp is alive and not exposed? (b) when perice=- 
mentitis has supervened on death of the pulp. 

(a) Oil of cinnamon. Oil of cloves. Tincture of aconite 
given internally in y 2 drop doses. 

(b) Tincture of aconite and tincture of iodine in equal 
parts applied to the gum over the affected tooth. 

in death from ether, which of the vital organs fail first? 

The organs of respiration. 

Mention (a) a coagulating antiseptic, (b) a non=coagu= 
lating antiseptic. 

(a) Carbolic acid, (b) Oil of cinnamon. 

Define astringents. Mention two vegetable and two 
mineral astringents. 

Astringents are remedies which cause contraction of mus- 
cular tissue, coagulate albumen and lessen secretions from 
mucous surfaces. In weak solutions, they act as tonics; in 
concentrated form they act as irritants and caustics. 

Vegetable astringents, tannic acid, krameria. 

Mineral astringents, alum, iron subsulphate. 

Define sialagogue. Mention one. 

Sialagogues increase the action of the salivary glands. 
Pilocarpine. 

Mention three alteratives and state the dose of each. 

Mercuric bichloride, -^ to y-j- gr. 

Potassium iodide, 5 to 60 grs. 

Fluid extract of stillingia, y± to 1 fluid dram. 

What is meant by the physiologic action of a drug? 

The physiologic action of a drug is the altered action, func- 
tion, and behavior of the tissue and organs while under its 
influence. 



THERAPEUTICS AND MATERIA MEDIC A. 239 

Arrange the following in the order of their efficiency as 
disinfectants; carbolic acid, bichloride of mercury, oil of 
cloves. 

Bichloride of mercury. Carbolic acid. Oil of cloves. 

Mention the drugs useful in the treatment of pyorrhea 
alveolaris and state their effects. 

Hydrogen peroxide attacks pus and dead tissue vigorously, 
destroying them by the liberation of oxygen. 

Hydro-naphthol is an efficient germicide for use after pus 
pockets have been otherwise cleansed. 

Aromatic sulphuric acid is useful to soften and remove cal- 
careous deposits, besides having marked antiseptic and stimu- 
lating properties. 

Describe the physiological action of amyl=nitrite. State 
the dose and the method of administering it. 

Amyl-nitrite stimulates the rate of heart beats, though not 
its force; vessels dilate, causing fall in arterial tension; the 
respiration is first stimulated, but later depressed; action on 
the nervous system — great depression of motor centres; tem- 
perature falls. 

The dose is three to five minims dropped on a napkin and 
administered by inhalation. 

What is cocaine hydrochlorate? How is it obtained? 
State its properties and dose. 

Cocaine hydrochlorate is an alkaloid obtained from the 
leaves of Erythroxylon Coca by removing the tannin from 
an aqueous infusion of the drug with lead subacetate, and the 
addition of sodium or potassium hydrate to alkalinity. Then 
it is agitated with ether and the ethereal portion evaporated. 
It is finally purified by repeated crystallization from alcoholic 
solutions after having neutralized the salt with hydrochloric 
acid. It occurs as colorless, transparent, odorless, neutral 
crystals, bitter to the taste. It is soluble in half its 
weight of water or alcohol, less soluble in chloroform, and 
almost insoluble in sulphuric ether. It acts first as a stimu- 
lant, but later as a narcotic and depressant. Dose "• s to 1 2 S r - 



240 THERAPEUTICS AND MATERIA MEDIC A. 

How many grains of a drug are necessary to make one 
pint of a i to 2000 solution? Write a prescription for 
a 1 to 2000 solution of bichloride of mercury. 

A pint of water weighs 7291.2 grains. A 1 to 2000 
solution contains 2W0 °^ a § ra ^ n i n every grain of water. 
Therefore, llii x 2W0 — number of grains in a pint of the 
solution; or 3.6456 grains. 

R . Bichloride of mercury gr. 3.6456 

Distilled water f J xvi 

M. Sig.— Use as directed. 

Name three drugs useful for sterilizing instruments. 
Describe a method of sterilizing a mouth mirror. 

Formaldehyde. 
Carbolic acid — 5% solution. 
Hydrogen dioxide. 

Sterilize a mouth mirror by immersing it in a 10% solution 
of formaldehyde for at least fifteen minutes. 

Name three heart stimulants administered hypodermi- 
cally in the order of their rapidity of action and state 
dose of each. 

Strychnine sulphate, dose -^ gr. 
Nitroglycerine, dose t ^q gr. 
Alcohol, dose 30 minims. 

What remedies should always be at hand to meet symp- 
toms of danger in giving anesthetics? 

Aromatic spirits of ammonia. 

Hypodermic tablets of strychnine sulphate. 

Amyl-ni trite. 

Tincture of digitalis. 

Alcohol (whiskey or brandy). 

Nitro-glycerin. 

Atropine. 

Give maximum dose of cocaine hydrochlorate for hypo- 
dermic administration to an adult. 

One-half grain. 



THERAPEUTICS AND MATERIA MEDIC A, 241 

Describe carbolic acid and creosote, (a) Where de- 
rived? (c) Their dental use. 

Carbolic acid occurs as clear, colorless (when fresh) inter- 
laced, needle-like crystals, which, after exposure to light ac- 
quire a pink to reddish tint. It liquifies by heat or on addi- 
tion of 10% of water or glycerine; has distinctive, slightly 
aromatic odor, and when diluted has a sweetish pungent taste. 
It has faint acid reaction, is soluble in alcohol, glycerine or 
water and coagulates albumin. Carbolic acid is obtained from 
coal tar by fractional distillation and subsequent purification. 
In full strength it is used for hypersensitive dentin, and 
in pulpitis as an anodyne. In carious cavities and putrescent 
pulp canals, it is useful as a germicide, antiseptic dressing, 
and as a caustic in treating ulcers. A 5% solution may be 
used as an antiseptic for sterilizing instruments, and in 
weaker solution as an antiseptic mouth wash. 

Creosote is an almost colorless, highly refractive oily liquid, 
turning red or brown on exposure to light. Its odor is pene- 
trating and smoky, with burning caustic taste. It is slightly 
soluble in water, fully so in alcohol, chloroform, ether and 
oils; does not coagulate albumin. 

It is derived from the fractional distillation of wood tar, 
that portion coming over between 205 and 220 degrees (Cen- 
tigrade) being collected as creosote. Its dental uses are very 
similar to those of carbolic acid, though not suitable for 
sterilizing instruments nor as a mouth wash, because of its 
insolubility in water. 

Write a prescription for a counter=irritant containing 
three drugs. 

B . Tincture of aconite 
Tincture of iodine 

Chloroform aa f 7, j 

M. Sig. — Apply as directed. 

How do cocaine and eucaine differ in physiological 
action? 

Eucaine has a very similar action to cocaine but does not 
16 



242 THERAPEUTICS AND MATERIA MEDICA. 

dilate the pupils nor interfere with accommodation. It does 
not affect the circulation nor respiration to any great ex- 
tent as does cocaine. 

Name five essential oils used in dental practice. 

Oil of cinnamon. 
Oil of cajuput. 
Oil of cloves. 
Oil of wintergreen. 
Oil of eucalyptus. 

(a) What are local anesthetics? (b) Mention three, 
(c) Describe the method of using them, (d) State the 
precautions necessary. 

(a) Local anesthetics are agents which produce insensibility 
of the part to which they are applied. 

(b) Cocaine hydrochlorate. 
Ethyl chloride. 

Carbolic acid. 

(c) Cocaine hydrochlorate is used hypodermically in 1 
to 5% solution. 

Ethyl chloride is used as a spray. 

Carbolic acid is applied to the surface in solutions up to 
10% for its benumbing effect which lasts several hours. 

(d) In the use of cocaine hydrochlorate hypodermically, 
have the syringe and solution perfectly aseptic, taking care 
not to inject an overdose. Have triturates of Y i~o grain of 
atropine sulphate always at hand, also morphine sulphate as 
antidotes. 

In the use of ethyl chloride care should be taken not to 
freeze the tissue too hard. 

In carbolic acid as an anesthetic, solutions stronger than 
10% irritate and have caustic effects. 

What is trichloracetic acid? (b) What are its prop- 
erties and dental uses? 

(a) It occurs as colorless crystals, very soluble in water, 
obtained by the oxidation of chloral by nitric acid. 



THERAPEUTICS AND MATERIA MEDICA. 243 

(b) It is of value in the quantitative estimation of albumin 
and as a caustic. Its dental uses are as an aid in removing 
calcic deposits, and in treatment of suppurating surfaces. 

Describe the properties, dental use and application of 
copper sulphate. 

Copper sulphate occurs in large blue crystals, permanent 
in the air, is odorless and has a bitter, metallic taste; it is 
soluble in about three parts of water. In strong solution 
it acts as a caustic and in dilute form as an astringent. In- 
ternally in doses of 5 to 10 grs. it is a certain and power- 
ful emetic. 

Dental use — valuable for its astringent properties. 

(a) From what is opium obtained? (b) Name two of 
its alkaloids, (c) State the adult dose of each. 

(a) Opium is the inspissated milky exudate obtained by 
the incision of the unripe capsule of Papaver Somniferum. 

(b) Alkaloids — morphine and codeine. 

(c) Dose, morphine % to ,% gr. ; codeine 14 to 2 grs. 

Write a prescription for the treatment of thrush, con= 
taining at least two drugs and a menstrum. 

K . Boracic acid % j 

Carbolic acid m v 

Glycerine 

Water aa f 3 iv 

Sig. — Use as a wash. 

How many grains of a drug are there in six fluid ounces 
of a 10% solution? 

A fluid ounce of distilled water contains 455.7 gr. Six 
fluid ounces therefore contain 2734.2 gr. 

A 10% solution must therefore contain - 2 - I rV 4 — , or 273.42 gr. 

What is the dose of carbolic acid for internal admin- 
istration? What are the chemical antidotes? 

Dose is % to 2 grs. 

Chemical antidotes — Albumin and sulphate of sodium or 
magnesium. 



244 THERAPEUTICS AND MATERIA MEDIC A. 

Describe the action of a saline cathartic. Name three 
and give the dose of each. 

Saline cathartics act by generally stimulating the secre- 
tion of intestinal fluids. This, together with increased peris- 
taltic movements, results in easy evacuation. 

Magnesium sulphate, dose y 4 to 1% ounces. 

Potassium and sodium tartrate, dose 14 to 1 ounce. 

Sodium phosphate, dose y± to 1 ounce. 

Define diffusible stimulants, (b) Give three examples 
and mode of administering each. 

Diffusible stimulants are stimulants which have a prompt 
but transient effect. 

Ammonia — by inhalation. 

Ether — by mouth or hypodermic injection. 

Alcohol — by mouth or hypodermic injection. 

Write a prescription containing an anodyne, a styptic, 
and an antiseptic to be used after extensive extraction 
of teeth. 

Fob Mrs. Carpenter. 

R . Acidi tannici 5 ii 

Acidi carbolici gr. xxx 

Sodii hydratis gr. x v 

Glycerini f 3 iv 

Aqu se f^ iiiss 

M. Sig. — Use as a mouth wash. 

Dr. . 

Give a rule for determining the amount of a drug re- 
quired to prepare a solution of a given percentage. 

Multiply the amount (expressed as grains) of the finished 
solution by the per cent, given, and divide by one hundred. 
The quotient will be the quantity in grains of the drug 
required. 

In what order are the nerve centres affected in general 
anesthesia? 

Nerve centres affected in general anesthesia are the brain, 
sensory side of spinal cord, motor side of spinal cord and 
finally the nerve centres in medulla. 



THERAPEUTICS AND MATERIA MEDIC A. 245 

What are the physiological effects of nitrous oxide gas? 

It is a stimulating narcotic and anesthetic. 

There is an increase in blood pressure, a sense of exhilara- 
tion, a ringing in the ears, followed by complete unconscious- 
ness. Anesthesia is probably due to the displacement of 
oxygen in the blood and to direct action of the gas on the 
cerebrum. 

Describe the preparation of nitrous oxide gas. 

Nitrous oxide gas is prepared by heating ammonium nitrate, 
the vapor of which is passed through three wash bottles con- 
taining, respectively pure water, solution of caustic potash, 
and solution of ferrous sulphate. 

State the dose, toxic effect, and antidote of arsenic, aeon* 
ite and morphia. 

Arsenic, dose -^ to y 1 ^ gr. 

Toxic effects are — faintness, nausea, epigastric tenderness, 
profuse diarrhoea, skin cold, pulse small and feeble. The 
antidote is freshly prepared ferric hydrate. 

Aconite (Tincture) dose is y 2 to 5 drops. 
(Solid extract) dose is 14 gr. 

Toxic effects — tingling sensation in the mouth, vomiting 
later, skin cold and clammy, pupils dilated, pulse small, weak 
and irregular, muscular weakness, death from asphyxia. 

Antidote — emetics, artificial respiration, keep patient warm, 
stimulate with brandy, ether, digitalis, atropine. 

Morphia, dose % to 14 gr. 

Toxic effects — pulse becomes slower, respiration is mark- 
edly reduced, reflexes become abolished, death occurs from 
paralysis of the respiratory centre, or carbonic acid accumu- 
lation in the blood. 

Antidotes — emetics in large doses, tannic acid as chemical 
antidote, strong coffee in stomach and rectum. 

Give the advantage and disadvantage of ether, chloro- 
form and nitrous oxide as general anesthetics. 

Ether. Advantages — administered with greater safety 



</ 



V 



246 THERAPEUTICS AND MATERIA MEDICA. 

than chloroform on account of lessened tendency to cardiac 
failure. 

Disadvantages — Tendency to produce struggling, and irri- 
tation to mucous membrane. It is highly inflammable, has 
disagreeable odor and is eliminated slowly. 

Chloroform. Advantages — not unpleasant odor, narcosis 
quickly accomplished without struggling, eliminated rapidly 
by the kidneys. 

Disadvantages — must be administered with great care as to 
admixture of air, contra-indicated in heart affections. 

Nitrous oxide. Advantages — pleasant to take, can be ad- 
ministered in sitting posture, nausea seldom occurs, dangers 
almost nil. 

Disadvantages — short duration of anesthesia, necessitating 
rapid operating. 

What is the physiological action and therapeutic use 
of arsenic? 

Physiological action — powerful caustic to all raw surfaces, 
gastro-intestinal stimulant in small doses; lessens the force 
and frequency of the heart's action; has great value in the 
treatment of chronic skin diseases. Its dental use is for 
devitalization of the tooth pulp. 

Describe the administration of nitrous oxide gas with 
precautions to be observed. 

Have patient remove all foreign substances from the mouth. 
See that mouth prop is securely fastened with cord. Avoid 
administration to patients under the influence of alcohol or 
opiates. Use an inhaler which permits of the administration 
of air with the gas. 

What is the first manifestation of danger in ether 
anesthesia? 

Sudden cyanosis, respiratory failure, weak rapid pulse. 

Name two drugs useful in failure of respiration under 
anesthesia. State properties, dose and how administered. 

Atropine, T ^ grain. It increases rapidity and depth of 
respiration by stimulating the respiratory centre. 



THERAPEUTICS AND MATERIA MEDICA. 247 

Strychnine, dose ^ to -fa gr., hypodermically. It also 
stimulates respiratory centre. 

Give method of administering ether and treatment in 
case of collapse. 

Open Method. Ether vapor given with large admixture 
of air. 

Closed Method. After first few respirations, ether vapor 
is given almost pure, only occasionally giving a breath of air. 
When full narcosis has been established, both methods are 
used alternately. In case of collapse, lower the head and 
raise the body, use artificial respiration, use inhalations of 
ammonia and amyl-nitrite, and injection, hypodermically, of 
strychnine, nitro-glycerin or digitalis. 

What are the advantages and disadvantages of local 
as compared with general anesthesia for extraction of 
teeth? 

Advantages in local anesthesia: less preparation of patient 
necessary, less time consumed, recovery immediate, no dread 
of unconsciousness, almost unlimited time for operation. 

Disadvantages are pain upon the insertion of needle, possi- 
bility of only partial anesthesia, and infection. 

Name three drugs or preparations useful in treating or 
protecting recently exposed pulps before filling the 
cavities. 

Oil of cloves. 

Campho-phenique. 

Solution of menthol in chloroform. 

Describe the methods of administering cocaine to pro- 
duce anesthesia. 

Topical and hypodermatical. 

In topical application, cotton is saturated with a 10% 
solution of the drug, placed over the part and allowed to re- 
main until sensation disappears. 

In hypodermatic use a 1% to 5% solution of the drug is in- 
jected into the part at various points. 



248 THERAPEUTICS AND MATERIA MEDIC A. 

Is general or local anesthesia the more suitable in oper= 
ations about the mouth? Explain. 

Local anesthesia is preferable in operations about the mouth 
because of the free field of operation, unobstructed by the 
presence of apparatus used in general anesthesia. 

What remedies are useful for relief of toothache caused 
by near approach of caries to the pulp? 

Bicarbonate of soda in paste with glycerine. 
Cocaine hydrochlorate. 
Essential oils. 



PHYSICS, CHEMISTRY AND 
METALLURGY. 



What is meant by specific gravity? 

Specific gravity, or relative weight, denotes the weight of 
a substance as compared with the weight of an equal bulk, 
or equal volume, of another substance, which is taken as a 
unit or standard. 

Describe a hydrometer. 

A hydrometer is a cylindrical glass vessel weighted at the 
bottom, terminating above in a thin glass stem, which is 
divided into equal spaces called degrees, and the degrees are 
usually numbered from 1000 at the top of the stem increasing 
downward towards the center of the instrument. It is em- 
ployed to determine the specific gravity of liquids. 

What is water of crystallization? 

Water of crystallization is such water, in solid form, as 
gives to a substance its crystalline shape and, frequently, its 
color. It is not in chemical union with the substance, and 
leaves when substance is heated to 212° F. 

What is the difference between deliquescence and 
efflorescence? Give examples of each. 

Some solid substances have the power of absorbing moisture 
from the air and are called deliquescent; such bodies may 
even be entirely liquified on exposure to air. The property 
certain crystallized substances have of losing water of 
crystallization when exposed to the air is known as efflores- 
cence ; such bodies lose their crystalline outlines and become 

(249) 



250 PHYSICS, CHEMISTRY AND METALLURGY. 

powdery. Calcium chloride and gold chloride show deliques- 
cence. Common alum and ferrous sulphate are efflorescent, 

What is meant by the specific heat of a metal? 

The specific heat of a metal refers to the ratio between the 
quantity of heat a given weight of a metal contains, and the 
quantity of heat the same weight of water contains, when 
both metal and water have the same temperature. It is 
often determined by observing the weight of ice melted by 
both the metal, and the same weight of water enclosed in 
a thin glass flask, when both, after being heated to the same 
temperature, cool to the same degree, in dried cavities in ice. 

Describe effervescence, hydrate, anhydride. 

Effervescence refers to the escape of a gas through a liquid, 
producing bubbling. A hydrate is a combination of a metal 
with a radical of the water type, as KHO. An anhydride is 
an oxide of an elementary substance, usually non-metallic, 
which will unite chemically with water to form an acid. 

Define elasticity. 

Elasticity is that property by virtue of which substances re- 
sume their former size and shape when they are relieved from 
the action of force upon them. 

Define separately the terms ductility, malleability and 
volatility, and give examples of each. 

Ductility is that property of matter by virtue of which it 
may be drawn into wire, e. g. gold, silver, platinum. 

Malleability is that property of matter by virtue of which 
it may be hammered or rolled out into sheets, e. g. gold, 
copper, tin. 

Volatility refers to the readiness with which substances pass 
into vapor, with or without heat, e. g. mercury, zinc, tin, 
iodine. 

Define anhydrous, alkaline, neutral. 

Anhydrous means deprived of water, as, anhydrous sulphate 
of copper. 



PHYSICS, CHEMISTRY AND METALLURGY. 251 

Alkaline refers to the property a substance has which, 
when in solution, turns red litmus paper blue, unites with 
and neutralizes acids, forming salts; emulsifies fats, making 
soap, and possesses harsh acrid taste. 

Neutral refers to that condition in which a substance show- 
ing neither acid nor alkaline properties, does not affect 
litmus in color. 

Define tenacity. 

Tenacity refers to the strength or resistance substances 
show to mechanical force seeking to pull their molecules apart. 
The tenacity of a metal expresses its resistance to fracture 
from a tensile or stretching force. 

What is meant by spectrum analysis. 

Spectrum analysis is a method for recognizing the pres- 
ence of different substances owing to characteristic optical 
effects produced when such substances are viewed through a 
prism. The substance examined, if a metal, is usually heated 
to incandescence, when the light it yields passing through a 
prism gives rise to characteristic bands or lines of color lead- 
ing to its recognition. 

Describe the construction of two galvanic cells and 
mention the chemicals used in each cell. 

Grove cell : Hard rubber cup filled with dilute H 2 S0 4 , con- 
taining "U" shaped strip of zinc. Immersed in this cup is 
a porous cup filled with strong nitric acid and a sheet of 
platinum. 

Grenet cell: This has two plates of carbon between which 
a plate of zinc may be raised out of, or lowered into the 
liquid, which latter consists of a mixture of sulphuric acid, 
potassium bichromate and wa/ter. 

What is meant by potential as applied to electric bodies? 

Potential represents the difference in positive and nega- 
tive conditions of a body, when its former condition of elec- 
trical equilibrium is disturbed by mechanical friction, as in 
rubbing glass, or molecular friction, as by chemical action. 



252 PHYSICS, CHEMISTRY AND METALLURGY. 

It represents a stored force, and is present before the wires 
are connected. It is to electricity what temperature is to heat, 
and is practically identical with tension and with electro- 
motive force. 

Describe in detail the process of electro=plating. 

This term is usually applied to process of depositing a film 
of silver on surfaces of articles made of German silver, 
brass, etc. 

The article to be plated is cleaned by immersing it in hot 
solution of caustic potash, and afterwards (often) in acid, and 
is well rubbed with a scratch brush. 

It is then dipped in a solution of mercuric nitrate, rinsed 
in water, and at once suspended by thin copper wire in the 
plating trough, which contains a solution of silver cyanide 
with an excess of potassium cyanide, and is connected then 
with the negative pole of a battery. 

From the positive pole of the battery a strip of pure silver 
is suspended in the liquid near to the article to be plated. 

A current is now passed through the arrangement when 
the silver solution is decomposed and silver is deposited upon 
the article, while the pure silver strip slowly dissolves, form- 
ing cyanide of silver in the solution, thus restoring the 
strength in metal that the plating solution is losing. 

Describe the apparatus for generating electric currents 
from chemical action. State the chemical action involved 
in the process. 

A sheet of copper and a sheet of zinc placed in dilute sul- 
phuric acid will generate an electric current because the zinc 
will be acted upon chemically by the acid more than the 
copper. A solution of sulphate of zinc will form in the 
acid, and hydrogen gas will be liberated to settle in bubbles 
on the copper sheet. 

Explain the structure and luminosity of a candle flame. 

The flame of a candle presents three well marked zones, or 
portions, best shown by lowering wire gauze upon the flame. 



PHYSICS, CHEMISTRY AND METALLURGY. 253 

Viewed in such fashion we find the innermost zone to be 
colorless, of low temperature and composed of the vapors aris- 
ing from the heating of the wax of the candle. 

The second zone has the highest temperature, and is the 
luminous portion of the flame, and is occasioned by the burn- 
ing or oxidation of the vapors of the inner zone, and owes 
its luminosity to particles of solid carbon heated to incan- 
descence from the active chemical changes of oxidation. 

The outer zone has a low temperature, and is composed of 
water vapor, carbon-dioxide and amorphous carbon, as the 
final result of burning of the wax of the candle. It is dark 
in color. 

Describe the Bunsen burner and give the chemistry of 
its flame. 

The Bunsen burner consists of a tube for the burning of 
gas, at the bottom of which are apertures for the admission 
of air. The air so dilutes the gas that all of the carbon of the 
gas undergoes combustion; carbon-dioxide and water result 
from burning. 

It presents two well marked zones of flame and a third 
surrounding very indistinct film. 

The inner flame is blue, pointed, of lower temperature and 
is known as the reducing flame, and its employment removes 
oxygen from bodies heated in it. 

The second flame is colorless, surrounds the inner flame, is 
of highest temperature, represents perfect combustion, is 
known as the oxidizing flame because metal heated in it readily 
combines with oxygen of the surrounding air. 

The film of practically invisible vapor surrounding these 
two flames is composed of water vapor and carbon-dioxide and 
has low temperature. 

Define cohesion, adhesion, gravitation. Mention in- 
stances in the action of each. 

Cohesion is an attractive force binding together molecules 
of like kinds and acts in the interior of bodies. Examples : 



254 PHYSICS, CHEMISTRY AND METALLURGY. 

cohesion combines the molecules of water into visible drops, 
unites the molecules of silica to form grains of sand, holds 
together molecules of gold to produce gold leaves. 

Adhesion is an attractive force binding molecules of unlike 
kinds together acting upon surfaces of bodies. Examples: 
water adheres to wood, glue to paper, alcohol to iodine. Both 
cohesion and adhesion require for their action that the sub- 
stances be practically in contact. Adhesion also unites masses. 

Gravitation is the attractive force which draws masses 
towards each other, acting when bodies are widely separated, 
as well as when in contact: Example, gravitation tends to 
keep the celestial bodies in their relative positions from the 
sun, occasions the fall of the apple from the tree to the earth, 
causes movement of the atmosphere. 

Describe the spectroscope and explain its use in a 
chemical analysis. 

A spectroscope consists of a tripod upon which is an optical 
prism and focused upon this latter are three telescopes, one 
of which is movable. A substance of unknown composition 
may be heated to incandescence before the distal end of one 
of the fixed telescopes and the light to which it gives rise 
enters through a narrow slit with parallel edges and passes 
through the prism. Here it is decomposed and the observer 
looking through the distal end of the movable telescope notes 
the effect of this decomposition of light from the object. 

The other immovable telescope is provided with a micro- 
meter scale which is reflected upon the prism by the light 
given by a burning candle placed at its distal end. 

This reflected scale allows the observer to locate any 
characteristic bands or lines of color or darkness that the light 
from the incandescent substance produces when passing 
through the prism. 

Thus, suppose a salt of unknown character to be heated 
to incandescence and when viewed by the observer through the 
movable telescope showed a field of blackness crossed verti- 
cally by a bright yellow line at a point in the scale marked 



PHYSICS, CHEMISTRY AND METALLURGY. 255 

"D," this would serve to recognize the substance as a salt 
of sodium, or the metal itself. 

Mention some conductors and some non=conductors of 
electricity, and explain their behavior in connection with 
the electric phenomena. 

Good conductors of electricity; silver, copper and gold. 

Good non-conductors; glass, silk, rubber. 

A good conductor offers little resistance to the passage of 
electricity over its surface. 

A non-conductor offers great resistance or impedence to 
electric flow. 

A conductor only remains electrified when surrounded by 
non-conducting, or insulating, material. 

Non-conductors, when electrified as by friction, retain 
their electrical charge for a considerable time, but although 
a conductor may be electrified it instantly loses such charge. 

Describe destructive distillation and describe the gases 
generally formed during that process. 

Destructive distillation is the resolution of a complex sub- 
stance into simpler forms under the influence of heat, out 
of contact with air. 

Soft coal if heated in earthenware retorts connected with 
cooled receivers, so as to exclude air, would undergo destruc- 
tive distillation, giving rise to gases and vapors including 
hydrogen, marsh gas, carbon monoxide, carbon dioxide, 
olefiant gas, nitrogen, etc. 

Define matter, force, energy. 

Matter includes all which the senses appreciate as having 
weight and occupying space. 

Force is that which produces motion, or tends to produce 
motion, or resists change. 

Energy is the capacity of any agent to do work. 

Distinguish the characteristics of matter in (a) the 
solid state, (b) the liquid state, (c) the gaseous state. 

(a) The solid state exhibits an independent form with 



256 PHYSICS, CHEMISTRY AND METALLURGY. 

cohesion strongly marked between the molecules, yet varying 
in degree so as to give rise to properties of hardness, ductility, 
malleability, tenacity, etc. 

Their shapes are often irregular; they do not unite after 
the passage through them of a cutting implement. They 
vary in elasticity. 

(b) In liquid state cohesive force is less marked although 
present. Liquids have no independent form, they unite after 
passage of a cutting implement, they present horizontal sur- 
faces, the particles move or flow freely over each other, they 
are perfectly elastic. 

(c) In gaseous state no independent form is present, co- 
hesion is absent, they unite after passage of cutting imple- 
ment, their particles tend to spread from each other, they 
exhibit tension or pressure, are perfectly elastic and uniformly 
compressible and expand equally when heated no matter what 
their composition. 

l^ What is (a) a permanent magnet, (b) an electro- 
magnet? State how each may be made. 

(a) A permanent magnet is one made of steel which once 
magnetized retains its magnetic properties indefinitely. 

It may be made from a steel bar by rubbing the bar with 
an existing magnet in various ways. 

(b) An electro-magnet is one that quickly parts with its 
magnetic properties, and as quickly regains them. 

It consists of a bar of soft iron enclosed in a coil of in- 
sulated wire, and when an electric current passes through 
this coil the soft iron bar becomes a magnet, but ceases to 
act as a magnet when the current of electricity no longer 
traverses the coil of insulated wire. 

What physical forces have a tendency to decompose 
compound substances? Give examples. 

Heat; as in the decomposition of mercuric oxide into mer- 
cury and oxygen. 

Light; as in decomposition of silver chloride into sub- 
chloride of silver and chlorine gas. 



PHYSICS, CHEMISTRY AND METALLURGY. 257 

Electricity; as in the decomposition of water into hydrogen 
and oxygen gases. 

Differentiate sensible heat, latent heat, specific heat. 

Sensible heat is that appreciated by the senses and indicated 
by the thermometer and is a measure of the intensity of heat. 

Latent heat is not appreciated by sense of touch or the ther- 
mometer, but is the heat a body requires to affect its change, if 
solid into a liquid, or if liquid, into a gas or vapor. 

Specific heat is the amount of heat a body contains com- 
pared with the heat an equal weight of water contains, when 
the body in question and water are at the same temperature. 

Define capillary attraction, absorption, diffusion, osmose. 

Capillary attraction is a modified form of adhesion, by vir- 
tue of which liquids ascend in small tubes to which they ad- 
here, or descend in tubes that they cannot wet. 

Absorption refers to the including of a substance, usually 
liquid or gaseous, into another substance, usually solid or 
liquid, without material increase in size of the absorbing 
body ; thus charcoal absorbs ammonia gas, water absorbs 
oxygen, etc. 

Absorption also refers, in optical phenomena, to the re- 
ceiving of light by a body but its failure to reflect or transmit 
such light or colors. Thus we speak of absorption spectra. 

Diffusion, if of liquids, is the gradual mixing of two liquids 
of different specific gravities when they are carefully placed, 
without mixing, in the same vessel, with the lightest liquid 
uppermost. 

Diffusion of gases refers to the intermingling or mixing 
of different gases. 

Osmose refers to the mixing of different liquids when separ- 
ated from each other by porous partitions. 

Define anode, cathode, circuit, electric current, induc= 
tive force, e!ectro=motive force. 

Anode is the name applied to the end of a positive wire 
or pole leading from a battery. 
17 



258 PHYSICS, CHEMISTRY AND METALLURGY. 

Cathode is the terminal of a negative wire or pole from a 
battery. 

Circuit is the pathway the electric energy is said to traverse 
from battery out along conduction material back into the 
battery. 

Electric current is the term applied to best describe the flow 
of electric energy from its source along its circuit. 

Inductive force is shown by the power of an insulated, 
charged conductor to act on nearby unelectrified bodies, as a 
magnet acts on soft iron. It decomposes their neutral electric 
fluid into positive and negative constituents attracting to itself 
the unlike and repelling the like electric fluid. 

Electro-motive force is the force that sets electricity in mo- 
tion causing the current to leave the cell or dynamo. It is 
the result of the tendency to re-establish equilibrium be- 
tween quantities of positive and negative electricity after 
such equilibrium has been disturbed. 

State the uses of electricity in generating heat, light, 
and mechanical motion, and in favoring chemical action. 

Heat generated by electricity may be employed in porce- 
lain furnaces for baking — may be used to reduce metal ores 
to metals, as in obtaining aluminum — may be used to melt re- 
fractory metals like platinum — to soften surface-hardened 
metals at certain points — to weld metals — for cooking and 
heating purposes, etc. 

Light obtained by electric action may be of great intensity 
and may be applied to examination of cavities of the body, 
as in the use of the endoscope, etc. 

Mechanical motion may be brought about by the action of 
an electric motor whereby motion is transmitted to various 
instruments such as the dental engines, lathe, etc. 

By electric force we may bring about the union of many 
simple bodies to form complex or compound ones; as hydro- 
gen and chlorine may be caused to unite by an electric spark ; 
or we may obtain the separation of substances formerly 
united, as by the electrolysis of gold chloride solution, yield- 
ing chlorine gas and gold. 



PHYSICS, CHEMISTRY AND METALLURGY. 259 

Describe a method by which electricity produces (a) 
heat, (b) light, (c) mechanical energy. Show that elec= 
tricity favors chemical action. 

(a) Pass a strong current along a poor conducting metallic 
wire, as platinum, bent in a loop, and from the impedence 
or resistance the current encounters, the metal is heated, 
forming an instrument for cauterizing. 

(b) Enclose a film of carbon in an exhausted glass globe 
and, in the absence of air, the carbon glows from incan- 
descence due to the heat arising from resistance to the pass- 
age of the current. 

(c) Pass the electric current through a coil of insulated wire 
that surrounds the bar of soft iron and the bar becoming 
magnetic draws to it an elastic hammer which it releases, to 
spring back and strike a bell, when the current ceases to 
flow through the coil of wire. 

Pass an electric spark into a mixture of hydrogen and 
oxygen gases; they combine with explosive violence to form 
water vapor. 

Describe a method of obtaining the specific gravity of 
(a) solids, (b) liquids, (c) gases. 

(a) To obtain specific gravity of solids divide the weight of 
the solid in air by the weight it loses when suspended and 
weighed in water. 

(b) To obtain specific gravity of liquids: Counter-balance 
an empty flask, then fill the flask with distilled water at 60° F., 
and find the weight of water the flask holds ; empty the flask 
and fill it with the liquid to be examined at 60° F. and find 
the weight of the liquid the flask holds; divide the weight 
of the liquid by the weight of water, the result being specific 
gravity of the liquid. 

(c) To obtain specific gravity of gases exhaust a large glass 
flask of air and counter-balance ; fill the flask with dry air at 
0° C, and at a pressure of 760 mm. as shown by the barometer, 
and find how much this bulk of air weighs — then exhaust the 
flask of air and fill with the eras to be examined at the same 



260 PHYSICS, CHEMISTRY AND METALLURGY. 

temperature and pressure and weight — divide the weight of 
the gas by the weight of air, the result will be the specific 
gravity. 

Mention four compounds, giving the formula and molec- 
ular weight of each. 

Water, H 2 0, molecular weight 18. 
Carbon dioxide, C0 2 , molecular weight 44. 
Sulphuric acid, H 2 S0 4 , molecular weight 98. 
Nitric acid, HN0 3 , molecular weight 63. 

Give the formula of carbolic acid. Mention an antidote. 

Carbolic acid, C 6 H 5 OH. 

Antidote, a soluble sulphate, as Epsom salt. 

Place the chemical formula after each of the following 
acids: Sulphuric, nitric, hydrochloric. 

Sulphuric acid, H 2 S0 4 . 
Nitric acid, HN0 3 . 
Hydrochloric acid, HC1. 

Give the formula of acetic acid, oxalic acid. 

Acetic acid, HC 2 H 3 2 ; Oxalic acid, H 2 C 2 4 . 

Give the common names of H 2 0, HN0 3 , H 2 CO s , and 
N 2 0. 

H 2 0, water ; HN0 3 , nitric acid or aqua f ortis ; H 2 C0 3 , car- 
bonic acid; N 2 0, nitrous oxide or laughing gas. 

Write the equation showing the reaction of sulphuric 
acid on common salt. State a general theory to this 
particular reaction. 

If two chemical compounds be brought in contact with each 
other under favorable conditions, should one or more elements 
of one of the compounds have an attraction or affinity for one 
or more elements of the other compound, these elements will 
leave their original compounds, and, uniting, form new bodies. 

H 2 S0 4 + NaCl==NaHS0 4 + HCl: or H 2 S0 4 + 2NaCl = 
Na 2 S0 4 + 2HC1. 



PHYSICS, CHEMISTRY AND METALLURGY. 261 

Give the chemical equation for the formation of water 
from its elements. 

2H 2 +0 2 +heat=2H a O. 

Give the formula and properties of (a) hydrochloric 
acid, (b) sulphuric acid, (c) sulphurous acid, (d) phos= 
phoric acid. 

(a) Hydrochloric acid (HC1) is a colorless gas, has a sharp 
penetrating odor, and is very irritating when inhaled. It is 
neither combustible nor a supporter of combustion, and has 
great solubility in water. Although hydrochloric acid is a 
gas this name is also employed for its solution in water. The 
hydrochloric acid of the U. S. P. is an acid containing 31.9% 
of HC1, and is a colorless, fuming liquid. 

(b) Sulphuric acid (H 2 SOJ. Pure acid has a specific 
gravity of 1.848; it is a colorless liquid, of oily consistency, 
and has a great tendency to combine with water, absorbing it 
readily from atmospheric air. Upon mixing sulphuric acid 
and water, heat is generated. It also has the property of de- 
stroying and blackening organic matter, and is corrosive and 
caustic. The sulphuric acid of the U. S. P. should contain 
not less than 92.5% of H 2 S0 4 . 

(c) Sulphurous acid (H 2 S0 3 ) is a colorless acid liquid 
which has the odor as well as the disinfecting and bleaching 
properties of dioxide of sulphur; it is completely volatilized 
by heat. The acid is easily oxidized by air to form sulphuric 
acid. 

(d) Phosphoric acid (H 3 POJ is a colorless, odorless, 
strongly acid liquid, which on heating loses water, and finally 
is volatilized at a low red heat. 

Place the chemical formula after each of the follow= 
ing compounds: Hydrogen sulphide, potassium iodide, 
calcium sulphite, magnesium carbonate, and mercuric 
chloride. 

Hydrogen sulphide, H 2 S ; potassium iodide. KI : calcium 
sulphite, CaSO.. ; magnesium carbonate, MgCO s ; mercuric 
chloride, HgCl 2 . 



262 PHYSICS, CHEMISTRY AND METALLURGY. 

Place after each of the following compounds its chem- 
ical formula: Silver chloride, zinc sulphate, calcium oxide. 

Silver chloride AgCl, zinc sulphate ZnS0 4 , calcium oxide 
CaO. 

Indicate by an equation the reaction of zinc with hydro- 
chloric acid. 

Zn 2 + 4HC1 = 2ZnCl 2 + 2H 2 . 

What chemical changes result from the addition of 
hydrochloric acid to silver nitrate? Answer by giving 
the equation. 

AgN0 3 + HC1 = AgCl + HN0 3 . 

Write the chemical formulae for sodium chloride, fer- 
rous sulphate. 

Sodium chloride NaCl, ferrous sulphate FeS0 4 . 

Complete the following equations: CuO + H 2 S0 4 ; Zn -J- 
2HCI; AgNO + NaCI. 

CuO + H 2 S0 4 == CuS0 4 + H 2 0, 
Zn + 2HCl = ZnCl 2 + H 2 . 
AgN0 8 + NaCl = AgCl + NaN0 8 . 

Write the formulae for ammonium hydrate and potas- 
sium nitrate. 

Ammonium hydrate NH 4 0H, potassium nitrate KN0 3 . 

Give common names for zinc sulphate, copper sulphate, 
aluminum oxide. 

Zinc sulphate — white vitriol. 

Copper sulphate — blue stone, or blue vitriol. 

Aluminum oxide — alumina or corundum. 

What is understood by H 2 S0 4 ? 

Twice the atomic weight of hydrogen in chemical combin- 
ation with once the atomic weight of sulphur in chemical com- 
bination with four times the atomic weight of oxygen, form- 
ing one molecule of sulphuric acid, representing 98 parts by 
weight of sulphuric acid. 



PHYSICS, CHEMISTRY AND METALLURGY. 263 

What does H 2 2 represent? 

One molecule or 34 parts by weight of pure hydrogen 
peroxide. 

Mention three acids used in medicine. Give the for- 
mula for each. 

Acetic acid, HC 2 H 3 2 . 
Sulphuric acid, H 2 S0 4 . 
Hydrochloric acid, HC1. 

State the law of Avogadro and explain its relation to 
modern chemistry. 

Law of Avogadro : Under like conditions of temperature, 
and pressure, equal volumes of all gases contain the same 
number of molecules. 

By this law we find gaseous molecules of all kinds to be 
equal in size so that by weighing equal volumes of a gas and 
of hydrogen, when subjected to the same temperature and 
pressure, we can at once establish the molecular weight, and, 
after analysis, deduce the molecular formula of the gas ex- 
amined, and in the case of elementary gases determine the 
atomic weights. 

Differentiate between oxidizing agents and reducing 
agents. 

An oxidizing agent is a substance that readily parts with 
some or all of the oxygen it contains, giving it up to combine 
with other substances — this action occurring in most instances, 
under the influence of heat. Thus potassium nitrate if heated 
with lead, copper, etc., yields oxygen to those metals form- 
ing metallic oxides and itself changing to potassium nitrite. 
Potassium chlorate and manganese dioxide are frequently 
used as oxidizing agents. 

A reducing agent is a substance anxious to combine with 
oxygen, so that it removes oxygen from other bodies : Thus 
when a mixture of charcoal and oxide of lead are heated, 
the lead oxide is reduced to form metallic lead, the carbon 
taking the oxvgen from lead oxide becomes carbon dioxide. 



264 PHYSICS, CHEMISTRY AND METALLURGY. 

Hydrogen passed over cupric oxide or ferric oxide when 
heated, acts as a reducing agent. 

Explain the chemical terms monad, diad, triad, etc. 
Give an example of each. 

A monad, if an element, would unite with hydrogen in 
the proportion of once its atomic or combining weight with 
once the atomic weight of hydrogen; or, the monad if vapor- 
ized, would unite in equal measured volume with hydrogen. 

Theoretically we state one atom of a monad combines with 
one atom of hydrogen. 

If the monad be a compound radical, like OH, then the sum 
of the atomic weights of its constituents unite with once the 
atomic weight of hydrogen. 

If the monad be a metallic element, or an electro-positive 
compound radical, its valency is shown by its power of dis- 
placing its own volume of hydrogen from compounds, or its 
combining weight will displace the combining weight of 
hydrogen from compounds ; or, we often fix its valency by its 
combining with one equivalent of chlorine weighing 35.5. 

A diad atom or radical combines with, or takes the place 
of two hydrogen atoms. 

A triad combines with, or takes the place of three hydrogen 
atoms. 

Among monads we have hydrogen, chlorine, potassium. 

Among diads we have oxygen, sulphur, calcium. 

Among triads we find nitrogen, boron, gold. 

Name two or more elements which ignite on contact 
with water. 

Sodium, potassium. 

What are the principal differences between metallic 
and non=metallic elements? 

A metallic element is solid at ordinary temperatures, with 
few exceptions. It has considerable weight, and is more or 
less malleable, ductile, and tenacious. It is opaque to light 
and is a good conductor of heat and electricity. It has luster, 



PHYSICS, CHEMISTRY AND METALLURGY. 265 

is electro-positive and forms at least one base with oxygen. It 
displaces hydrogen from acids to form salts. Substances not 
possessing these characteristics are grouped as non-metals. 

By what principle do elements combine to form com- 
pounds? 

In obedience to the laws governing chemical affinity; those 
atoms or radicals in unlike electrical conditions uniting to 
form compounds. 

Give examples of analysis and synthesis. 

Heating mercuric oxide produces the metal mercury and 
the gas oxygen (analysis). 

Passing an electric spark through a mixture of equal 
volumes of hydrogen and chlorine produces hydrochloric 
acid (synthesis). 

Passing a galvanic current through water we have produced 
one volume of oxygen and two volumes of hydrogen ( analysis) . 

Heating one volume of oxygen and two volumes of hydrogen 
they unite with explosion to form water (synthesis). 

Why are the salts of some metals called sulphides, 
sulphites, and sulphates? 

Sulphides are binary compounds, one of the two elements 
present being sulphur. Sulphates and sulphites are ternary 
compounds, known as oxy-salts, containing sulphur, oxygen 
and a metal; the sulphates contain a larger number of 
oxygen atoms in each molecule than the sulphites. 

What are the essential properties of an acid? 

(a) It always contains hydrogen, which is wholly or par- 
tially replaceable by metals to form salts. 

(b) It changes the color of many organic substances, litmus 
changing from blue to red. 

(c) It has (when soluble in water) an acid or sour taste. 

(d) It unites with and neutralizes a base to form a salt 
and water. 

(e) It corrodes tissues when concentrated. 



266 PHYSICS, CHEMISTRY AND METALLURGY. 

By what force do atoms unite to form compounds? 
Give an example. 

By the force of chemical affinity favored by the action 
of one or more physical forces. 

Example, H,+Cl 2 +electric spark=2HCl. 

What is a chemical equation? 

It is a writing, or diagram, representing upon one side of 
an equality sign the formulae of substances separated by plus 
signs, that when in contact, exert chemical action upon each 
other, leading to their decomposition, and upon the other side 
of the equality sign are placed the f ormulse of the new bodies, 
separated from each other by plus signs, that result from this 
chemical action. 

How is molecular weight obtained? Give illustrations. 

Molecular weight is obtained by ascertaining the sum of 
the atomic weights, or multiples of the atomic weights, of the 
constituents of the molecules ; or, by taking twice the density 
of a compound compared with hydrogen when both are in a 
gaseous state. 

Molecular weight of H 2 0=2+16 or 18. 

Vapor density of H 2 0=9, then 9X2=18. 

Molecular weight of H 2 SO =2+32+64 or 98; or, vapor 
density of H 2 S0 4 is 49, then 49X2=98. 

What is meant by chemical reaction? 

Chemical reaction represents by formula the re-arrange- 
ment of atoms and radicals after, through chemical action, 
they have been separated from their former union. 

What is the difference between two acids composed of 
the same elements, the name of the one ending in " ous " 
and that of the other in " ic "? Illustrate by giving 
name and formula. 

The acid that is most stable' in composition, or of most 
importance, or is of greatest use, or from which salts of great 
importance are derived has its name terminating in "ic." 



PHYSICS, CHEMISTRY AND METALLURGY. 267 

The acid whose name terminates in "ous" contains a less 
number of oxygen atoms in each molecule than the acid 
ending in "ic. " 

Examples, sulphuric acid H 2 S0 4 , nitric acid HN0 3 . 

Examples, sulphurous acid H 2 S0 3 , nitrous acid HN0 2 . 

Distinguish between an element and a compound. 
Give an example of each. 

An element is a substance, the molecules composing which, 
contain the same kind of atoms ; for example, copper, gold. 

A compound is a substance, the molecules composing it be- 
ing formed of different kinds of atoms, e. g. water, alcohol. 
Upon an element no force exerted will produce any other 
kind of matter than that originally present. 

A compound may, by the exertion of certain forces, be de- 
composed, yielding different kinds of matter than the orig- 
inal substance. 

Describe the chemical process by which minerals are 
converted into animal foods. 

Mineral substances in the soil are dissolved in water, which 
often contains carbon dioxide or alkaline silicates, thus con- 
verting such mineral substances into soluble alkaline, or 
double salts. The rootlets of plants absorb such mineral 
material when in solution, and store it up in the plant, after 
the mineral substance undergoes chemical change into or- 
ganic salts, as tartrates, citrates, acetates, etc., of the metal 
originally present in the mineral. The animal eating such 
plants then appropriates these organic salts after effecting 
their change, in the animal body, into such salts as carbon- 
ates, phosphates, sulphates, etc. 

Give an example of (a) a physical change, (b) a chem= 
ical change, (c) a mixture, (d) a chemical compound. 

(a) The dissolving of salt in water, the melting of ice. 
fb) Union of silver with nitric acid to form silver nitrate; 
union of oxygen and hydrogen to form water. 

(c) Iron filings mixed with sulphur: sand mixed with sugar. 



268 PHYSICS, CHEMISTRY AND METALLURGY. 

(d) Apply heat to iron filings when they unite chemically 
to form ferrous sulphide which exhibits different properties 
than either iron or sulphur when alone. 

Classify the following acids, bases or salts: (a) lime, 
(b) vinegar, (c) cream of tartar, (d) baking soda, (e) 
ammonia. 

Acids Bases Salts 

Vinegar Lime Cream of tartar 

Ammonia Baking soda 

Define negative elements, positive elements. Men= 
tion the conditions under which negative and positive 
elements act on each other. Illustrate this action. 

A negative element is one which if freed from a compound 
by electrolysis would be found at the positive electrode. A 
negative element is one that combines with oxygen to form 
an acidulous compound. A negative element is a metalloid. 

A positive element is one which when freed from a com- 
pound by electrolysis appears at the negative electrode. A 
positive element is one that combines with oxygen to form a 
basic or neutral oxide. A positive element is a metal. 

Negative and positive elements combine when in nascent or 
atomic conditions, when in contact, and when the exertion of 
a physical force favors the union. 

How is matter classified? 

Simple and compound. Mineral, animal and vegetable. 

Organic, inorganic and organized. 

Atom, molecule and mass. 

Solid, liquid, gaseous, and radiant. 

In what condition are elements generally found in 
nature? Mention two exceptions. 

In combination with other elements forming compounds. 
Exceptions, carbon as diamond and oxygen mixed with nitro- 
gen in atmospheric air ; in these instances carbon and oxygen 
are in their elementary forms. 



PHYSICS, CHEMISTRY AND METALLURGY. 269 

Define atom, molecule. 

An atom is the smallest indivisible particle of elementary 
matter, not capable of self-existence but passing from one 
compound to another in chemical interchanges. 

(New.) An atom is an aggregation of a definite number of 
corpuscles or electric units, oscillating as a whole; upon the 
number and rapidity of movement of these corpuscles, the 
chemical identity of the atom depends. 

A molecule is the smallest part of any substance that can 
exist alone and exhibit the properties of the substance. It 
is a cluster of two or more atoms bound together by chemi- 
cal affinity. 

What is meant by analysis? 

Analysis is the name given to the process of separating ele- 
ments from compounds or compounds from complex struc- 
tures, leading to the recognition of elements or compounds 
that exist in more complex bodies. Analysis is the process 
of determining the composition of a body by separating its 
constituents. 

What is synthesis? 

Synthesis is the name given to the process of producing 
substances by bringing about the union of their constituent 
elements, or simpler compounds. 

For what element is there the most extensive affinity? 

Oxygen. 

State how to obtain an atomic weight. 

The atomic weight equals 6.4 divided by the specific heat of 
the element. We may also obtain the atomic weight by not- 
ing in what weight the element, if it be a monad, will replace 
one part by weight of hydrogen in an existing compound. 

By obtaining its vapor density compared with hydrogen. 

Define electrolysis. Describe an experiment illustrate 
ing it. 

Electrolysis consists of the separation of the constituents 



270 PHYSICS, CHEMISTRY AND METALLURGY. 

of a compound through the action of an electric current. 
Iodine may be separated from potassium by passing an elec- 
tric current through a solution of potassium iodide, when, if 
starch mucilage be present, the liberated iodine combines with 
it to form bluish-black iodide of starch. 

State the theory of valency. 

Valency expresses the numerical power for union by 
volume, which different elementary substances show, com- 
pared with one volume of hydrogen. Theoretically it indi- 
cates the number of hydrogen atoms required to unite with 
or to take the place of one atom of another element, or radical. 

Distinguish between alkali and alkaloid. 

An alkali is a soluble base. 

It is an oxide or hydrate of an alkaline metal. It is a 
mineral substance whose solutions turns red litmus blue. It 
neutralizes acids to form salts and water. It forms soaps 
with fats. When strongly heated it leaves a residue. 

An alkaloid is an active principle of an organic substance 
and is alkaline in reaction. It always contains nitrogen and, 
in addition, carbon, hydrogen and often oxygen. It is called 
an organic base. An alkaloid when heated burns with an 
odor of burning feathers, then forms a black char, and on 
continued heating entirely disappears. 

By what process are constituents of compounds ob- 
tained? Give an example. 

By electrolysis and by heat. Separation of oxygen and 
hydrogen from water by electrolysis. Separation of oxygen 
and mercury from mercuric oxide by heat. 

Explain the use of atomic weights. 

Atomic weights are used as combining weights, giving us 
the proportion by weight of one element required to unite 
with a definite weight of a second element in forming a 
compound. 



PHYSICS, CHEMISTRY AND METALLURGY. 271 

Distinguish between a simple molecule and a compound 
molecule. 

A simple molecule is composed of atoms of the same kind. 
A mass of such molecules is known as an element. 

A compound molecule is composed of atoms of different 
kinds. Such molecules in mass are spoken of as compounds. 

Mention two ways in which elements occur in nature, 
and give examples of three elements occurring in both 
these ways. 

In uncombined state, as oxygen mixed with, but not in com- 
bination with nitrogen in air; as nitrogen found elementary 
in air ; as carbon found elementary in diamonds, in graphite. 

In compounds or unions with other elements: As oxygen 
combined with metals occurring as oxides, as nitrogen found 
combined as salts called nitrates, in the soil; as carbon exist- 
ing combined as carbonates united with different metals, as 
in limestone. 

Explain the use of symbols and formulae. Give and 
translate five examples of each. 

A symbol is used to represent one atom of an elementary 
substance. 

A formula is a combination of symbols that represents one 
molecule of a substance. 

Examples of symbols : Oxygen, ; hydrogen, H ; sulphur, 
S; nitrogen, N; chlorine, CI. 

Examples of formulas : Water, H 2 ; nitric acid, HN0 3 ; 
sulphuric acid, H 2 S0 4 ; hydrochloric acid, HC1; ozone, 3 . 

What is the difference between a mixture and a chem= 
ical compound? 

Mixtures are joined together by adhesion and cohesion, and 
can be separated by such physical means as heat, magnetism, 
solution, etc., and the constituents may be mixed in any pro- 
portion, and when mixed do not lose their characteristic prop- 
erties nor give rise to heat. A chemical compound is one 
joined through chemical force, differs in properties from 



272 PHYSICS, CHEMISTRY AND METALLURGY. 

those of its constituents, forms only on combining definite 
weights of constituents, and its production is accompanied 
by heat. 

Mention a test by which organic compounds may be 
distinguished from inorganic compounds. 

On heating the substance, if it be organic, it first chars 
and then burns entirely away, leaving no residue; if it be 
inorganic, it does not char and although strongly heated 
leaves a residue, (except in the case of ammonia compounds, 
and water, which do not leave residues when heated). 

Define (a) monad, (b) diad; (c) give examples of each. 

(a) A monad is an element or compound radical whose 
atom or radical has the power of replacing one atom of hydro- 
gen from a compound, or combining with one atom of hydro- 
gen; examples, potassium, sodium, silver. 

(b) A diad is a substance whose atom or radical has the 
power of replacing two hydrogen atoms from a compound, or 
requires two hydrogen atoms with which to combine; ex- 
amples, oxygen, sulphur, calcium. 

Explain how it is that heat both oxidizes certain metals 
and de=oxidizes their oxides. 

Heat brings about the union of the oxygen of the air and 
certain base metals like copper, which when heated in air 
forms cupric oxide. An intense heat weakens chemical affin- 
ity, so that if a body desirous of combining with oxygen be 
heated with a metal oxide the oxygen leaves the metal to join 
the other substance; thus, cupric oxide heated with charcoal 
produces the metal copper and carbon monoxide and carbon- 
dioxide. 

Very high temperatures as exist in the sun prevent chemi- 
cal union of elements. 

Heat of low intensity may occasion combination with 
oxygen, as when barium monoxide changes to barium dioxide 
when heated in air; and on raising the temperature this new 
compound again produces barium monoxide and oxygen. 



PHYSICS, CHEMISTRY AND METALLURGY. 273 

State and illustrate the law of multiple proportions. 

If two elements, "A" and "B," enter into chemical com- 
bination with each other in more than one proportion the 
quantities of B which unite with a fixed quantity of A will 
bear a simple ratio to each other. Nitrogen and oxygen com- 
bine in five distinct proportions with each other : thus 28 parts 
by weight of nitrogen combines with 16, 32, 48, 64, and 80 
parts by weight of oxygen. Eepresenting nitrogen by A we 
then find that to every seven (7) parts by weight of nitrogen 
there will unite 4, 8, 12, 16, or 20 parts of oxygen, which we 
represent by B. 

i/ Define potential as applied to electro-chemistry. 

It refers to the stored charge of either negative or positive 
electricity held by the ion at the moment of its dissociation. 

Define chemical affinity and state how it differs from 
other forces. 

Chemical affinity is the attractive force which acts between 
atoms of matter. In its action it differs from the molecular 
or physical forces in acting upon atoms, in being accompanied 
in its action by heat, in producing new substances as a result 
of its action, and in acting inside the molecules of matter. 

Physical forces act outside the molecules. 

Both chemical affinity and physical forces act at inappre- 
ciable distances. 

Molar forces, like gravitation, etc., act upon masses and 
often when they are widely separated. 

Differentiate, from a chemical standpoint, animal life 
and vegetable life. 

Chemical changes that occur in plants are more those of 
synthesis, while in animals analytical changes predominate. 

The plant takes as food simple substances or compounds, 
and constructs them into complex bodies. 

The animal takes as food complex bodies yielded by plants 
and decomposes them into simpler bodies, transposing their 
potential energy into kinetic. 
18 



274 PHYSICS, CHEMISTRY AND METALLURGY. 

The products of vegetable chemical activity are frequently 
crystalline and may often be artificially produced. 

The products of animal chemical activity are usually fibrous 
or cellular, and cannot be manufactured. 

Define a chemical compound. Mention three chemical 
compounds. 

A chemical compound is a substance whose molecules are 
composed of different kinds of atoms. Examples; Water 
H 2 0, alcohol C 2 H 5 OH, ammonia NH S . 

What is analytical chemistry? State the object of (a) 
qualitative analysis, (b) quantitative analysis. 

It is that department of chemistry that has to do with the 
separation of compounds or complex structures into simpler 
ones, and the recognition and estimation of these simpler sub- 
stances. 

(a) Qualitative analysis seeks to ascertain the different 
kinds of elements composing compounds or compounds pre- 
sent in complex structures. 

(b) Quantitative analysis seeks to determine the amount of 
elements present in a definite quantity of a compound or the 
amount of simple compounds existing in a given quantity of 
a complex structure. 

Differentiate organic chemistry and inorganic chem= 
i.stry. 

Organic chemistry is the chemistry of the hydro-carbons 
and their derivatives. The number of elements in organic 
compounds is usually small; but the number of atoms in the 
molecule is frequently large. 

Organic chemistry treats of substances composing vegetable 
and animal structures and the products of animals and plants. 

Organic chemistry treats largely of compound radicals. 

Inorganic chemistry is the chemistry of mineral substances ; 
is largely a study of elementary matter and their combinations. 

Number of atoms in a molecule is usually few. 



PHYSICS, CHEMISTRY AND METALLURGY. 275 

Mention four chief elements that enter into organic 
compounds. 

Carbon, hydrogen, oxygen, and nitrogen. 

State one of the reasons for regarding the atomic weight 
of oxygen as 16 instead of 8. 

Its density compared with hydrogen is 16, not 8. 

Explain the following terms: Slow combustion, com- 
bustible substances, supporter of combustion. 

Slow combustion refers to oxidation of a substance, the pro- 
cess extending over considerable time, and being unaccom- 
panied by evolution of light and with scarcely perceptible in- 
crease of temperature. 

A combustible substance is one which under proper condi- 
tions unites chemically with other bodies giving rise to heat 
and light. 

A supporter of combustion is a substance, like oxygen, in 
which a combustible substance will burn, (undergoing rapid 
oxidation) . 

Give two methods of obtaining hydrogen. 

(1) By the action of zinc on sulphuric acid. 

(2) By the electrolytic decomposition of water, and col- 
lection of hydrogen in a tube placed over the negative 
electrode. 

Describe the preparation of hydrogen. 

Place zinc in dilute sulphuric acid and hydrogen gas will 
be evolved which may be collected in jars previously filled 
with water ; while in the dilute acid, sulphate of zinc will 
be produced. 

(a) What is hydrogen? (b) State some of its chem= 
ical relations. 

Hydrogen is a colorless, odorless, tasteless gas, the lightest 
of the well known elements, its symbol is H, atomic weight 1, 
valency 1, condition electro-positive. 

It combines with all non-metals and with a few of the 
weaker metals like arsenicum and stibium. 



276 PHYSICS, CHEMISTRY AND METALLURGY. 

Give two methods for obtaining oxygen. 

The oxides of the noble metals are decomposed at a low 
temperature; so, heat red oxide of mercury, obtaining oxy- 
gen gas. 

Potassium chlorate, KC10 3 is decomposed by heat into 
potassium chloride, KC1 and oxygen gas. 

Mention three methods for obtaining oxygen. 

(1) Heat barium peroxide above a red temperature when 
barium monoxide and oxygen gas are produced. 

(2) Heat a mixture of potassium chlorate and manganese 
dioxide, when oxygen gas is evolved at a comparatively low 
temperature. 

(3) Pass a galvanic current through water and collect 
oxygen gas in a tube placed over the positive electrode; such 
oxygen resulting from the decomposition of water. 

What is the compound of oxygen and another element 
called? 

An oxide. 

What is ozone? Name some of its properties. 

Ozone, 3 , is a blue, irritating, and irrespirable gas, heavier 
than air, readily soluble in ether, turpentine, etc. 

It occurs naturally, in very minute quantity, in pure air, 
particularly near pine forests, the sea-shore, and where large 
films of water undergo rapid evaporation. 

It oxidizes substances more energetically than oxygen, act- 
ing upon substances like silver, that resist the action of ordi- 
nary oxygen. 

It bleaches, disinfects, and strongly oxidizes. 

How can it be determined that the composition of 
water is H 2 0? 

By passing an electric current through water, and by so de- 
composing it we obtain two volumes of hydrogen and one 
volume of oxygen weighing respectively 2 for hydrogen and 
16 for oxygen. (Analysis). 



PHYSICS, CHEMISTRY AND METALLURGY. 277 

By mixing two volumes of hydrogen, weighing, say 2 grains 
and one volume of oxygen, weighing, say, 16 grains, and pass- 
ing an electric spark through the mixture, the result will 
form 18 grains or two measured volumes of water vapor. 
( Synthesis. ) 

Distinguish between oxygen and ozone. 

Oxygen is a colorless gas, no difficulty is experienced in 
inhaling it, its molecule contains two atoms. 

Ozone has a blue color, is so irritating when inhaled as to 
produce hemoptysis, when concentrated. Ozone is far more 
active in producing oxidation of substances than is oxygen; 
its molecule contains three atoms. 

What influence has temperature on a mixture of hy= 
drogen and oxygen? 

A high temperature causes their chemical union to form 
vapor of water, such formation accompanied by explosive 
violence. 

How is hydrogen dioxide obtained and what is its for= 
mula? 

It is obtained by the decomposition of barium dioxide sus- 
pended in water on adding sulphuric acid, Ba0 2 +H 2 S0 4 = 
BaS0 4 +H 2 2 . The H 2 2 thus obtained is not pure, but con- 
tains a considerable quantity of water. From this aqueous 
solution we can obtain a 50% solution by evaporation at a 
temperature not exceeding 140° F. If this product is placed 
in vacuo over strong sulphuric acid, a nearly pure or 100% 
syrup-like hydrogen dioxide results. 

State the use of H 2 2 . 

It is used as a disinfecting, bleaching and oxidizing agent. 

What chemical change occurs in the action of H 2 2 as 
a germicide or antiseptic? 

1I 2 2 , in contact with organic matter, particularly pus, is 
decomposed into water and nascent oxygen. The oxygen so 
freed destroys the germ or rendering the soil non-fertile. 



278 PHYSICS, CHEMISTRY AND METALLURGY. 

Explain the reaction of H 2 2 on putrescent pulps. 

In contact with pus H 2 2 is decomposed into water and 
nascent oxygen, and the oxygen then acts on morbific matter, 
oxidizing it into harmless substances. 

Name the elements of the chlorine group. Give brief 
and separate descriptions of their properties. 

Fluorine, chlorine, bromine, iodine. 

Fluorine : A yellow gas, heavier than air, most active of 
all chemical elements, monad in valency, electro-negative, al- 
ways existing combined as fluorides of metals, as calcium 
fluoride. 

Acts chemically upon water forming hydrofluoric acid and 
ozone. Very corrosive, has bleaching and disinfecting prop- 
erties, has marked affinity for hydrogen, silicon, etc. Does 
not combine chemically with oxygen. 

Chlorine: A green gas, readily liquified, two and a half 
times the weight of air, is monad in valency, .electro-negative, 
combines with most elements, never found elementary, exists 
universally in combination with sodium in mineral, animal 
and vegetable substances, is a strong bleaching agent, is dis- 
infectant, and indirectly, through its affinity for hydrogen, 
acts as an oxidizing agent. 

Unites with some of the metals with such vigor as to oc- 
casion true combustion, as with antimony, arsenic, etc. 

Less active in its chemical combinations than fluorine, is 
soluble in water, exerting a slight decomposing effect upon 
water. 

Bromine: A heavy red liquid, three times the weight of 
water, giving rise to orange-red fumes at all temperatures, 
is monad, electro-negative, less active chemically than F or 
CI. It bleaches, disinfects and indirectly oxidizes. It 
forms no oxides. It is used as a caustic, combines with 
most metals and some of the non-metallic elements, its binary 
metallic salts are nervous depressors. 

Iodine : Occurs as a blue-black, scale-like solid, five times 
the weight of water, volatile at all temperatures, color of 
vapor, violet, monad, electro-negative. 






PHYSICS, CHEMISTRY AND METALLURGY. 279 

It possesses the properties of the other members of this 
group, although it is less active ; is slightly soluble in water, 
more soluble in alcohol and freely so in ether and chloroform. 

Describe a method of preparing chlorine. 

Heat hydrochloric acid and manganese dioxide and collect 
the heavy chlorine gas that is evolved by downward dis- 
placement in empty jars. 

4HC1 + Mn0 2 = MnCl 2 + 2H 2 + Cl 2 . 

How is muriatic acid prepared? Give the equation. 

By roasting a mixture of sodium chloride and sulphuric 
acid and passing the resulting gas, HC1, into water. NaCl + 
H 2 S0 4 =NaHS0 4 +HCl. 

Give the symbol and the method of preparation of 
iodine. State the use of iodine in dentistry. 

Iodine, I, is prepared from any iodide by the action of a 
mixture of manganese dioxide and sulphuric acid. 

2KI+Mn0 2 +2H 2 S0 4 =K 2 S0 4 +MnS0 4 +2H 2 0+I 2 . 

The tincture is a counter-irritant, astringent and antiseptic, 
in the latter office particularly useful in the last stages of 
putrefactive decomposition. In strong tincture, combined 
with tincture aconite, it is applied to the gums in chronic 
pericementitis as a counter-irritant. In diluted tincture it 
is applied as an antiseptic and astringent in cases of con- 
gestion of the gums and pyorrhea alveolaris. It is useful 
in removing green stain. 

State the three allotropic forms of carbon. 

Diamond, graphite, lampblack. 

Name some of the purer forms of carbon as found in 
nature. 

Diamond, graphite, and anthracite coal or fossil carbon, 
often containing as high as 92% of carbon. 

What per cent, of C0 2 exists permanently in air? What 
per cent, of C<X is dangerous to life? 

Four parts of C0 2 exist permanently in 10,000 parts of 



280 PHYSICS, CHEMISTRY AND METALLURGY. 

air, or .04%. More than 6 parts of C0 2 in 10,000 parts of 
air, if the C0 2 is accompanied by respiratory impurities, is 
dangerous to life. 

Air containing one-twelfth of its volume of pure C0 2 will 
produce suffocation. 

Mention three great natural sources of C0 2 . 

Respiration of animals, burning of carbonaceous matter, 
decomposition of carbonates by heat or chemical action, 
alcoholic fermentation. 

State the conditions in which carbon is found in nature. 

It is found elementary in graphite and diamond. 

Is found combined in many gaseous forms, as CO, C0 2 , 
CH 4 , C 2 H 4 , etc. ; and exists combined in minerals as car- 
bonates and bicarbonates, is found in the composition 
of all animal and vegetable structures and occurs in large 
deposits in the many kinds of coal. 

Give the physical and chemical properties of carbon in 
each of three modifications. 

Diamond, hardest of substances, crystallizing in modifica- 
tions of regular octahedra, density 3.5, possesses the strong- 
est of refracting power, disperses light, poor conductor of 
electricity and heat, its chemistry is that of almost pure carbon. 

Graphite occurs imbedded in rocks in steel-gray foliated 
masses, sometimes in hexagonal tablets, can be scratched with 
the finger nail, makes black mark on paper, density 2.2, con- 
duces heat and electricity. 

Lampblack is a soft, amorphous powder obtained from the 
incomplete combustion of carbonaceous matter; it contains 
tarry matter, is impure and is used in making printer's ink 
and paint. 

In chemical properties, each form of carbon is electro-nega- 
tive, is indisposed to enter into chemical union directly, ex- 
cept with oxygen, sulphur and a few elements. Carbon has 
an atomic weight of 12, is diad and tetrad in valency and 
is a solid non-metallic element. 



PHYSICS, CHEMISTRY AND METALLURGY. 281 

How does N 2 rank as a supporter of combustion and 
of respiration? 

N 2 supports combustion but not as well as pure oxygen. 
It supports combustion only through its decomposition by the 
heat of introduced articles, practically producing a mixture 
of two volumes of nitrogen and one of oxygen. 

It does not support respiration of animals. 

Describe the manufacture of N 2 0. 

N 2 is obtained by heating ammonium nitrate, that has 
been fused, at a temperature between 470° F. and 490° F. 
The vapor so produced is then passed through three jars 
containing water, ferrous sulphate solution, and potassium 
hydrate solution; the gas is then liquified by pressure, in 
steel cylinders, in which form it is sold. 

How many nitrogen acids are there? State the name 
and formula of each. 

Nitric acid, HN0 3 ; nitrous acid, HN0 2 ; hypo-nitrous acid, 
HNO or possibly H 2 N 2 2 . 

Describe ammonia and give its chemical formula. 

Ammonia, NH 3 , is a colorless gas, each molecule of which 
is composed of once the atomic weight of nitrogen in chemical 
combination with three times the atomic weight of hydrogen. 

It is the second lightest compound gas, has a pungent, irri- 
tating, irrespirable odor, burns feebly, has a strong acrid 
taste, is corrosive and is the strongest of basic substances 
called the volatile alkalies. It is very soluble in Avater form- 
ing with water a chemical compound known as ammonium 
hydrate. It combines with acids to form salts without dis- 
placing the hydrogen of the acids. 

Write the formula of ammonia. State how ammonia 
is formed in nature. 

Ammonia, NH 3 . It is formed naturally as the result of 
decay of nitrogenous matter, of organic nature, in the pres- 
ence of moisture, due to bacterial action, and is given off 
to the air in vaporous forms, or is deposited in soils com- 
bined, as nitrates, nitrites or chlorides of ammonium. 



282 PHYSICS, CHEMISTRY AND METALLURGY. 

State the physical and chemical properties of nitrogen. 

Nitrogen, symbol N, atomic weight 14, valency 1, 3, 5. 
Is electro-negative, combines with but few elementary sub- 
stances, is inert, but enters into the composition of many 
active bodies, as the alkaloids, the proteid foods, the volatile 
alkali, and explosives. It is capable of being liquified and 
solidified by cold and pressure, is without color, odor or 
taste, is slightly lighter than air, and is soluble in water to 
the extent of 2% by volume. It is neither combustible nor 
a supporter of combustion. 

Mention the principal constituents of atmospheric air 
and state the proportions in which these constituents are 
present. 

Volume Weight 

Oxygen 20.93 23 

Nitrogen 79.07 77 

Including about 1% of argon, water vapor .5 to 1%, carbon 
dioxide .04. 

Traces of ammonia and nitric acid. 

Mention some decompositions by which ammonia is 
generated. 

By heating equal weights of quick lime and ammonium 
chloride, ammonia gas will be produced. 

Ammonia gas is produced during the destructive distilla- 
tion of soft coal in illuminating gas manufacture. 

Ammonia gas forms during the putrefaction of nitrogenous 
organic matters. 

Describe a method by which the four chief constituents 
of atmospheric air may be determined. 

Pass a weighed quantity of air successively through tubes 
or bulbs containing : First tube, calcium chloride ; second tube, 
solution of caustic potash; third tube, copper heated to red- 
ness; fourth tube, magnesium heated to redness. 

Water vapor will be retained in the first tube, the increase 
in weight of which will indicate the amount of water vapor 
in the quantity of air employed. 



PHYSICS, CHEMISTRY AND METALLURGY. 283 

Carbon dioxide will be retained in, and increase the weight 
of, the second tube. 

The quantity of oxygen from the air employed will be de- 
noted by the increase in weight of the third tube. 

Nitrogen combining with magnesium will indicate by the 
increase in weight its quantity in the air examined. 

(a) Name and briefly describe the two principal ele- 
ments of the atmosphere, (b) Are these elements free 
or in chemical combination. 

(a) Oxygen and nitrogen. 

Oxygen : symbol O, atomic weight 16, specific gravity 1.1056, 
valency 2. 

It is a colorless, odorless, tasteless gas, capable of being 
liquified and solidified by cold and pressure. It is soluble to 
the extent of 3% in water, is electro-negative, forms chemical 
union with all well-known elements but fluorine. 

Exists in air, and is dissolved in water, in elementary form, 
and is found in chemical compounds of animal, vegetable 
and mineral kingdoms. Constitutes one-third of all matter 
of the earth, supports combustion and respiration, is not 
poisonous, but in concentrated form acts as a general stimu- 
lant; it presents one allotropic form known as ozone. May- 
be obtained by strongly heating potassium chlorate. 

Nitrogen : symbol N, atomic weight 14, specific gravity 
.971, valency 1-3-5. 

It is a colorless, odorless, tasteless gas, capable of being 
liquified and solidified, less soluble in water than oxygen, is 
electro-negative and very inert chemically, but enters into 
the formation (in its atomic condition) of very active chemical 
substances, as ammonia, proteids, alkaloids, explosives, etc. 

Number of elements with which it combines is limited. 

Obtained by passing atmospheric air over copper heated to 
redness, which withdraws from the air its oxygen. 

(b) These two elements exist free or elementary, only 
being mechanically mixed to form air. ' 



284 PHYSICS, CHEMISTRY AND METALLURGY. 

* Mention three acids commonly employed in dentistry 
and give the specific use of each. 

Sulphuric acid — Local application to root canals, used for 
refining gold, for cleaning plates, as a solvent. 

Nitric acid — Used for refining gold, dissolving metals, as 
an oxidizing agent. 

Glacial phosphoric acid — Its solutions are added to zinc 
oxide in making oxy-phosphate of zinc cement. 

What is aqua regia and its principal property? 

Aqua regia is a mixture of water, nitrosyl chloride and 
chlorine gas, obtained by adding one to two parts strong nitric 
acid to four to five parts strong hydrochloric acid. 

It is a solvent for gold and platinum. It is also used 
medicinally. 

Mention four of the principal elements found in the 
human body. 

Oxygen, hydrogen, carbon and nitrogen. 
What proportion of air is nitrogen? 

Nitrogen constitutes about four-fifths of atmospheric air. 

Name the constituent elements and properties of the 
atmosphere. 

Oxygen, nitrogen, argon, and a few recently discovered 
elements. The atmosphere has no color, odor, or taste; it 
is 14.4 times the weight of hydrogen; can be liquified and 
solidified by cold and pressure; it exerts a pressure at the 
sea level of 14.7 pounds per square inch; it readily supports 
combustion from the oxygen that it contains. It is a me- 
chanical mixture, and as such its composition slightly varies. 

(a) Describe the chemical changes that occur in the 
process of bleaching, (b) Name two bleaching agents 
employed in dentistry. 

(a) Chlorine acts to bleach in the presence of moisture, 
combining with the hydrogen of water to form HC1, and 
liberating nascent oxygen, which latter oxidizes and so de- 
stroys coloring matter. 



PHYSICS, CHEMISTRY AND METALLURGY. 285 

Peroxide of hydrogen in watery solution. 

(b) Chlorine, as in chlorine water or chlorinated lime. 

Peroxide of hydrogen in contact with organic coloring 
matter is decomposed into water and nascent oxygen, and 
this latter destroys coloring matter. 

Describe the occurrence of sulphur in nature. 

Sulphur is found near volcanoes mixed with soil; it also 
occurs as crystalline deposits in rock. It is found naturally 
combined with most metals forming metallic sulphides, as of 
lead, zinc, mercury, etc. ; also occurs in metallic sulphates, as 
of calcium sulphate, barium, sodium, magnesium; it exists 
in water as alkaline sulphides, as sulphur dioxide and as 
sulphuric acid. 

It is present in combination in many animal fluids and 
tissues, as albumin, hair, horn, etc. It exists in many vege- 
table substances, particularly such as yield oils of great 
pungency, as mustard, horse radish. 

Mention with regard to sulphur, (a) atomic weight, 
(b) valency, (c) color, (d) odor, (e) taste, (f) solubility, 
(g) behavior when heated. 

(a) 32; (b) 2, 4, 6; (c) lemon yellow; (d) none (but its 
dioxide has a characteristic odor) ; (e) none; (f) insoluble in 
water, slightly soluble in hot alcohol and in chloroform, 
freely soluble in carbon disulphide and in alkaline solutions; 
(g) melts at 115° C. Becomes viscid at 200° C. to 250° C; 
when it adheres to vessel when inverted, again becomes thin 
and liquid above 250° C, boils at 440° C. 

What is blue vitriol? Describe the manufacture of 
blue vitriol and state its properties. Mention the uses 
in dentistry of blue vitriol. 

Blue vitriol is cupric sulphate CuS0 4 5H 2 0. It is manu- 
factured by dissolving copper in sulphuric acid; is also ob- 
tained as a by-product in silver refining. It occurs as blue 
prismatic crystals, astringent, freely soluble in water. 



286 PHYSICS, CHEMISTRY AND METALLURGY. 

In dentistry it is used, dissolved in ammonia, as an astrin- 
gent and styptic. It is a source from which pure copper may 
be obtained. It is used in several forms of galvanic cells. 

Give the name and properties of H 2 S0 4 . Describe the 
manufacture of H 2 S0 4 . 

H 2 S0 4 is sulphuric acid. It is a highly corrosive, strongly 
acid, heavy, oily-like liquid. It is known as one of the min- 
eral acids. It combines with water producing great elevation 
of temperature. It dissolves many metals; its specific grav- 
ity is 1.8. 

Sulphur or a sulphide is burned in air and the resulting 
S0 2 gas, together with nitric acid gas and steam, passed into 
a series of leaden-lined chambers. These three vaporous sub- 
stances combine to form sulphuric acid, which, first vapor- 
ous, liquifies and falls in a rain to the floor of the chamber; 
from this it is removed and concentrated by evaporation. 

What is CaS0 4 and what are its uses in dentistry? 

CaS0 4 , containing water of constitution, is gypsum. On 
being roasted it parts with a portion of its water, forming 
plaster-of-paris. This latter substance is used for taking im- 
pressions or models of the interior of the mouth. Moulds 
of plaster are also used for the deposition, by electrolysis, 
of metal. 

How does plaster=of=paris differ chemically from quick- 
lime? 

Quick-lime is oxide of calcium, CaO. 

Plaster-of-paris is dehydrated sulphate of calcium. 3CaS0 4 . 
2H 2 0. (Bloxham). 

Describe the simplest test for sodium and potassium 
salts in solution. 

Concentrate the solution, clean a platinum wire and wetting 
it in the solution, hold it in the inner Bunsen flame, when 
the outer flame will be colored yellow if sodium be present, 
and violet or pink if potassium be present. If both metals 
are present observe the yellow flame that sodium yields 



PHYSICS, CHEMISTRY AND METALLURGY. 287 



through blue glass, when the flame that potassium yields 
may be seen. 

Describe the preparation of plaster=of=paris. Explain 
the setting of p!aster=of=paris. 

By roasting gypsum at temperatures between 300° F and 
400° F., it loses about two-thirds of its water of constitution, 
and is then powdered. In the setting of plaster the water 
with which it is mixed unites with the plaster-of-paris to 
give a substance containing slightly less water of constitu- 
tion than gypsum before being roasted. 

Name the chemical constituents of saliva. 

Water 994.10 

Solids 

Ptyalin 

Epithelium and proteids( including serum, 

albumin, globulin, mucin, etc.) 

Fat 

Salts : 

Potassium Sulpho-Cyanate, 

Sodium Phosphate, 

Calcium Phosphate, 

Magnesium Phosphate, 

Sodium Chloride, 

Potassium Chloride. 



1.41 

2.13 

0.07 



2.29 



1000. 

State the salts that enter into the formation of human 
bone. 

Calcium phosphate, sodium chloride, magnesium phosphate, 
calcium fluoride, calcium carbonate. 

What is the difference between assay and analysis? 

An assay is a process for determining the proportion by 
weight of one or several substances in a complex body, as, 
for instance, the amount of silver in a silver ore, or the 
amount of morphine in a specimen of opium. 




288 PHYSICS, CHEMISTRY AND METALLURGY. 

Analysis is used for determining the proportion by weight 
of all substances in a compound, whether metallic or non- 
metallic in character. 

Give an antidote for sugar of lead. 

Antidote for sugar of lead: A soluble sulphate, as sul- 
phate of magnesium. 

Give the properties of phosphoric acid and describe the 
official process of making it. 

Ortho-phosphoric acid, H 3 P0 4 . 

It is a colorless, odorless, strongly acid liquid, is tri-basic, 
forming three classes of salts. It does not coagulate albumin, 
it yields precipitates with most metallic salts in solution. 

It is decomposed by heat parting with one or two mole- 
cules of water formerly held in combination. In its purest 
form, it is a crystalline solid. 

It is manufactured by boiling amorphous phosphorus in 
nitric acid, and when the phosphorus has entirely dissolved, 
the liquid is concentrated in platinum vessels until all of 
the nitric acid passes off, then water is added and the liquid 
placed over strong sulphuric acid under a bell jar, when 
all water evaporating, hard transparent crystals of ortho- 
phosphoric acid remain. 

This acid dissolved in water forms strong liquid phosphoric 
acid of 85% strength. 

Dilute phosphoric acid consists of lOOcc. of 85% acid and 
750cc. of water, and contains 10% of absolute phosphoric 
acid. 

Differentiate glacial phosphoric acid and common phos= 
phoric acid, and state in what respect the action of the 
former on the animal system differs from the latter. 

Glacial phosphoric acid has the composition P 2 5 , 
H 2 O=2HP0 3 . 

Ortho-phosphoric acid (or common phosphoric acid) has 
the composition P 2 5 , 3H 2 0=2H 3 P0 4 . 

Glacial phosphoric acid usually sold in sticks, resembling 
oaustic potash, but more glass-like in appearance. 



PHYSICS, CHEMISTRY AND METALLURGY. 289 

Ortho-phosphoric acid of 85% strength is dispensed in 
liquid form. 

Glacial phosphoric acid is poisonous, coagulates albumen, 
does not give a precipitate with magnesium sulphate, am- 
monium hydrate and ammonium chloride. 

Ortho-phosphoric acid is comparatively harmless, does not 
coagulate albumen, and forms a precipitate with magnesium 
sulphate, ammonium hydrate and ammonium chloride. 

What chemical product of bacteria is present in dental 
caries? (a) Does this product act on the mineral salts 
of the teeth? (b) If so, how? 

Lactic acid, (a) Yes. (b) By forming soluble salts at- 
tended by loss of tooth structure through solution. 

From what is lactic acid obtained? Describe a process 
of obtaining lactic acid and state its use in dentistry. 

It is obtained from sour milk and many other organic sub- 
stances. It is manufactured by allowing fermentation of a 
mixture of 8 parts cane sugar, 50 parts water, 1 part cheese, 
3 parts chalk, to continue for several weeks; this results in 
the formation of calcium lactate, and this is decomposed on 
the addition of sulphuric acid and alcohol, when the liquid, 
decanted, and allowed to stand, loses its alcohol through 
evaporation, leaving pure lactic acid as a colorless, strongly 
acid liquid. Its use in dentistry rests largely upon its power 
to dissolve calcium phosphate and carbonate, and thus to 
decalcify teeth. 

Name four organic acids. 

Lactic acid, acetic acid, oxalic acid, butyric acid. 

State the composition and properties of oxalic acid. 
Describe the manufacture of oxalic acid, and mention an 
antidote for oxalic acid poisoning. 

Oxalic acid H 2 C 2 4 , accurs as colorless, transparent crys- 
tals, soluble in water, odorless, very acid, and highly poisonous. 

It is manufactured by making a paste of caustic potash, 
caustic soda and sawdust, and heating this for several hours 
19 



290 PHYSICS, CHEMISTRY AND METALLURGY. 

on iron plates ; then boiling the resultant with lime and water, 
then decomposing the calcium oxalate so formed by adding 
sulphuric acid, filtering and allowing the liquid to evaporate, 
when oxalic acid crystallizes. 

An antidote for oxalic acid poisoning is chalk or a soluble 
salt of calcium. 

What is fermentation? 

Fermentation is the decomposition of non-nitrogenous or- 
ganic substances produced through the agency of nitrogenous 
bodies called ferments. 

What are alkaloids? Name three. 

Alkaloids are active principles of organic substances. They 
all contain nitrogen, and are alkaline in reaction. They are 
called organic bases. Morphine, strychnine and quinine are 
three alkaloids. 

'What is the source of tartaric acid? Give its use in 
medicine. 

It is the acid of the grape, occurring as acid tartrate of 
potassium, and when grape juice undergoes fermentation, 
this salt being insoluble, forms hard concretions, known as 
argols, deposited in the casks. 

From this substance tartaric acid is manufactured by add- 
ing to it lime forming calcium tartrate, and then adding sul- 
phuric acid, filtering and crystallizing tartaric acid from the 
• liquid. In medicine it is used to lower cardiac action and to 
give acidity to the urine. 

Give the manufacture of chloroform. 

Chloroform is obtained by distilling a mixture of bleach- 
ing powder, water, lime and alcohol, and is purified by add- 
ing sulphuric acid, decanting, neutralizing with soda and re- 
distilling with quick lime. 

Mention (a) two disinfectants; (b) two antiseptics. 
Give an example of the use of each. 

S0 2 , sulphur dioxide and H 2 2 , hydrogen peroxide, are two 



PHYSICS, CHEMISTRY AND METALLURGY. 291 

disinfectants. Sulphur burned in a room produces S0 2 , 
which destroys germs. Hydrogen peroxide in official solu- 
tions is added to collections of pus, when by direct oxidation, 
it destroys the germs present. 

Bichloride of mercury and boric acid are two antiseptics. 
The site of an operation, bathed by a solution of one part of 
bichloride of mercury in 2000 parts of water, renders the field 
of the operation non-fertile for development of germs. Boric 
acid in 3% watery solution applied to the eye prevents the 
development of germ life. 

(a) Give a brief description of the chemical properties of 
alcohol. (b) Name its two principal forms. (c) How 
and from what is each derived? 

(a) Alcohol is a water in each molecule of which one hydro- 
gen atom has been replaced by an alcohol radical or a 
hydro-carbon radical. It is a neutral substance, inflammable, 
lighter than water, a marked solvent particularly for gums 
and resins, is hygroscopic, and when burned yields a large 
amount of heat. 

(b) Methylic or wood alcohol. Ethylic or grain alcohol. 

(c) Wood alcohol is obtained by destructive distillation of 
wood in closed retorts, to the result of which sodium hydrate 
is added, and this mixture redistilled. 

Grain alcohol is obtained by distilling the results of fer- 
mentation of starchy or sugary liquids. 

State the formula of (a) common (ethylic) alcohol, (b) 
sulphuric ether, (c) acetic acid. 

(a) C 2 H 5 OH. (b) (C 2 H 5 ) 2 0. (c) HC 2 H 3 2 . 

Mention three alkaloids, giving their uses in dentistry. 

Morphin, as acetate, sulphate or muriate, is used in de- 
vitalizing mixtures and as an obtunding agent, and for 
temporary relief of odontalgia, is used internally for relief 
of facial neuralgia. 

When used as an obtunding agent it is usually combined 
with carbolic acid and oil of cloves. 

Cocain: its salts are used as local anesthetics and anodynes 



292 PHYSICS, CHEMISTRY AND METALLURGY. 

especially in alveolar pyorrhoea, extirpation of pulps of teeth 
and that of hypersensitive dentine; for extraction of teeth, 
in lotions for neuralgia and odontalgia. 

Atropin, as sulphate used locally as an obtunding agent, 
etc., and internally for neuralgia, etc. 

State the general, physical and chemical properties of 
an alkaloid. 

An alkaloid may be liquid but is usually solid. It is usu- 
ally of crystalline form, generally white in color, but slightly 
soluble in water, its salts being more soluble, the alkaloid 
is more soluble in alcohol and ether and most in chloroform. 
An alkaloid burns with an odor of burning feathers, then 
chars and finally burns entirely away, leaving no residue. 
Chemically, all alkaloids contain nitrogen along with carbon 
and hydrogen, the fixed alkaloids contain oxygen, while vola- 
tile alkaloids have no oxygen in their composition. They 
are all basic, though their salts may be neutral. They com- 
bine to form salts with acids without displacing the hydro- 
gen of the acid. They are tertiary and secondary amines, 
they all form precipitates with tannic acid, with fixed alka- 
lies, and with solutions of some metallic salts. 

Give the chemical constituents of (a) dentine, (b) 
enamel. State the properties of each constituent men- 

tioned. A) 

Organic substances and water. . . . 27.70 3.60 

Inorganic substances 72.30 96.40 

Inorganic substances included in 
100 parts of ash: 

Calcic phosphate 91.32 93.35 

Calcic carbonate , 1.61 4.80 

Calcic oxide 5.27 .86 

Calcic sulphate 09 .12 

Magnesic carbonate 75 .78 

Iron oxide 10 .09 

traces 

of 
fluorine 



PHYSICS, CHEMISTRY AND METALLURGY. 293 

Inorganic substances give rigidity, form, hardness, and re- 
sistance to tooth structure; organic substances are largely in- 
strumental in the nutrition of the tooth including its blood 
and nerve supply. 

Define metallurgy. 

Metallurgy is the science that treats of the economical ex- 
traction of metals from their ores, and the application of 
metals to useful purposes. It includes a description of each 
metal. 

What is a metal? 

A metal is an element, usually solid at ordinary tempera- 
tures, having considerable weight, being more or less malle- 
able, ductile and tenacious. It possesses lustre, is opaque to 
light and is a good conductor of heat and electricity. It is 
electro-positive, is capable of displacing hydrogen from acids 
to form salts, and will form at least one basic oxide with 
oxygen. 

Name three metals and give the symbol and atomic 
weight of each. 

Iron, Fe, 56. 
Gold, Au, 196.6. 
Aluminum, Al, 27. 

Mention three heavy metals. Give the symbol and 
atomic weight of each. 

Gold, Au, 196.6. 
Platinum, Pt, 197. 
Mercury, Hg, 200. 

Name some of the more malleable metals. 

Gold, silver, tin, copper, aluminum, platinum. 
What metal is the best conductor of heat? Of elec= 
tricity? 

Silver is the best conductor of both heat and electricity. 
Give the atomic weight and the symbol of gold, silver. 
Gold, Au; atomic weight 196.6. Silver. Ag. 108. 



294 PHYSICS, CHEMISTRY AND METALLURGY. 

Compare gold, silver, copper and tin as to conductivity 
of heat. 

Best in conducting power for heat is silver, followed in 
order by copper, gold and tin. 

Mention the two groups into which metals are divided. 

Noble metals and base metals. 

Differentiate metallic element, metallic compound, and 
amalgam. 

A metallic element under the action of any force will not 
give rise to any other substance than its original self. It is 
electro-positive and exhibits the properties known as metallic. 

A metallic compound is one usually consisting of a chemi- 
cal union of a metal with a non-metallic element or radical, 
and on its decomposition will yield two or more different 
substances than its original self, one of which substances will 
be of metallic character. 

An amalgam is a combination of one or more metals 
with mercury. 

Give the atomic weights and the symbols of (a) three 
heavy metals, (b) three light metals. 

(a) Osmium, Os, 198.5; iridium, Ir, 192.5; platinum, Pt, 
195.4. 

(b) Aluminum, Al, 27; magnesium, Mg, 24; potassium, 
K, 39. 

Give the name and atomic weights of each of the foN 
lowing: Ca, AI, Ni, P, Pt. 

Ca, calcium, 40 ; Al, aluminum, 27 ; Ni, nickel, 58 ; P, phos- 
phorus, 31; Pt, platinum, 195.4. 

Give the comparative thermal and electrical conductiv- 
ity of gold, silver and tin. 

Conducting power for both heat and electricity is in order, 
first silver, second gold, third tin, of the metals mentioned. 



PHYSICS, CHEMISTRY AND METALLURGY. 295 

Mention some metals having (a) very low fusing points, 
(b) very high fusing points. 

Metals of low fusing point include mercury, sodium, potas- 
sium, tin, lead, (b) Metals of high fusing point include 
osmium, iridium, platinum, iron, nickel. 

State why an alloy becomes brittle when heated. 

When heated an alloy more readily undergoes oxidation 
than its component metals by themselves, and the oxides 
formed dissolve in the remaining metallic substances and by 
their presence diminish cohesion of the particles of the alloy 
by preventing perfect contact between those particles. 

State the requisite properties of metals used for dies. 

Hardness, non-contractility on cooling, fusibility at low 
temperatures, marked cohesiveness or absence of brittleness. 

State two processes of joining metals. 

Welding and soldering. 

Give the comparative thermal and electric conductivity 
of tin, silver, platinum and gold. 

Conducts heat Conducts electricity 

Tin 14.5 12.36 

Silver 100 100 

Platinum 8.4 18.80 

Gold 53.2 77.96 

Write the names of ten metals used in dentistry. State 
the proportion that this number of metals bears to the 
entire number of known metals. 

Gold, platinum, silver, zinc, tin, lead, mercury, iron, 
copper, bismuth. 

These represent about one-sixth the number of known me- 
tallic elements. 

Name three metals which are excellent conductors of 



296 PHYSICS, CHEMISTRY AND METALLURGY. 

electricity, heat and cold. Are these properties desirable 
or objectionable in metal=base dentures? Give reasons. 

Silver, gold, copper. 

Such properties are objectionable because their change of 
volume endangers permanency of the denture and of the 
union of teeth to the plate; as conductors of heat and elec- 
tricity such metals cause irritation to sensitive parts, are apt 
to induce galvanic conditions in the mouth when filled teeth 
are also present, and affect the remaining healthy teeth from 
sudden changes of temperature. 

Explain the differences between annealing and temper* 
ing metals, and give an example of each process. 

Annealing a metal consists in heating a metal to a red heat 
and then (usually) letting it slowly cool. 

This process of annealing, or softening a metal, allows the 
molecules that have been forced into unnatural positions by 
hammering, etc., to again become normally- related to each 
other. It restores lost malleability and ductility. 

Tempering a metal is usually performed by first heating 
the metal to redness and cooling instantly as by plunging in 
cold water — this makes the metal hard and brittle ; the metal 
is then slowly heated to a particular temperature, consider- 
ably below redness, and is then cooled quickly, the result be- 
ing to remove some but not all of the hardness occasioned 
by its initial heating. 

Example of annealing: — Gold after hammering becomes 
hard and brittle but when heated to redness and allowed to 
cool slowly in the air its softness and malleability is again 
restored. 

Example of tempering: — A dental instrument (lancet) 
after manufacture is first heated to cherry-red heat and then 
cooled by plunging in cold water: it may then be heated in 
the flame of a spirit lamp at some distance from its cutting 
edge and rotated while in the flame so as to heat all parts 
equally until the end of the instrument acquires a pale straw 
color due to the formation of a thin film of oxide (indicating 



PHYSICS, CHEMISTRY AND METALLURGY. 297 

a temperature of about 430° F.) when it is at once plunged 
into cold water. 

Place the chemical symbols after each of the following 
elements: Lead, tin, aluminum, antimony, nickel. 

Lead, Pb. ; tin, Sn. ; aluminum, Al. ; antimony, Sb. ; 
nickel, Ni. 

Place after each of the following metals its chemical 
symbol: Gold, platinum, silver, tin, and copper. 

Gold, Au. ; platinum, Pt. ; silver, Ag. ; tin, Sn. ; copper, Cu. 

Name five metals all of which can be manufactured into 
wire, sheet, or foil. 

Gold, silver, platinum, copper, aluminum. 

What constitutes the difference between a noble metal 
and a base metal? Give examples of each. 

A noble metal is one having so feeble an affinity for oxygen 
as to be incapable of rusting or tarnishing by oxidation in 
air when cold or heated, and whose oxide when formed can 
be decomposed by heat alone at temperatures not above a 
red heat. 

Among noble metals are gold, mercury, silver, platinum, 
iridium. 

A base metal is one which oxidizes in air at ordinary tem- 
peratures, or when heated, and whose oxide requires heating 
at a high temperature with the presence of a reducing agent 
in order to undergo decomposition. 

Among base metals we find lead, tin, zinc, iron, copper. 

Mention the only three metals which are attracted to 
the magnet and which can themselves become magnets. 

Iron, nickel and cobalt. 

Describe five metals and give the fusing point of each. 

Tin (fusing point, 442° F.) is a soft, silvery white, malle- 
able, metal, and is present in solder. It readily volatilizes 
when heated. 



298 PHYSICS, CHEMISTRY AND METALLURGY . 

Lead (fusing point. 617° F.) is a bluish, soft, malleable, 
ductile metal; is slightly tenacious, resists the action of sul- 
phuric acid, undergoes oxidation when melted. 

Zinc (fusing point, 779° F.) is a silver- white, highly crys- 
talline, brittle metal; it is ductile and malleable when heated 
to certain temperatures. It is used in solder, and its oxide, 
forming when the metal is burned, enters into the composition 
of dental cements. 

Gold (fusing point, 2012° F.) is a yellow, soft, most malle- 
able and ductile metal, is insoluble in single acids, does not 
oxidize in air, and is markedly cohesive, welding when cold. 

Copper (fusing point, 2192° F.) is a flesh-colored, or red- 
dish, malleable metal, harder than gold ; it is ductile, tenacious 
and tough; is after silver the next best conductor of both 
heat and electricity, it enters into the formation of many im- 
portant alloys, like brass, bronze, german silver. 

What special properties of metals are most affected by 
alloying? 

Malleability and ductility are lessened, tenacity and hard- 
ness are increased, fusibility is lowered, sonorousness is in- 
creased. 

How does alloying affect the ductility of the noble 
metals? 

If noble metals are alloyed with base metals ductility is 
markedly lessened. 

A few noble metals like gold and platinum, or platinum 
and iridium are ductile when alloyed. The general rule is 
that the ductility of alloys is less than that of the constituent 
metals. 

How does alloying a pure metal usually affect its (a) 
tenacity, (b) ductility, (c) malleability? 

(a) Tenacity is increased, (b) ductility is lessened, (c) 
malleabilitv is lessened. 



PHYSICS, CHEMISTRY AND METALLURGY. 299 

What metals and alloys are used for dies and counter- 
dies? State for which each is best adapted. 

Lies Counter dies 

Type metal of PbgSbiSnj used with Lead 

Zinc used with Type metal 

Babbitt's metal Cu^b.^ Sn a or, 

Babbitt's metal Cu 1 Sb 2 Sn 24 used with Lead 

Haskell's metal CujS^S^ used with Lead 5, tin 1 

Tin 5, antimony 1. 

Lead, tin, bismuth, antimony, cast iron. 

What conditions are essential for the perfect welding 
of metals, whether hot or cold? 

Perfect cleanliness. 

Freedom from oxidation, or deposits of metallic salts. 
Application of considerable compressing force. 
Selection of the proper metals. 

Describe the difference between welding and soldering 
metals, (b) Is a new alloy formed of the metal and sol= 
der at the lines of union? 

Soldering is a process by which two or more pieces of metals 
are united by means of a fusible alloy termed a solder. It 
always requires the application of heat and does not require 
the exertion of a compressing force, and in its performance 
it is customary to employ a flux, and, as a rule, the union 
effected by it is less firm than that brought about by welding. 

Often in soldering, different metals or alloys may be joined 
to each other. 

In welding, like metals are united through the exertion of 
considerable force without the use of a fusible alloy, and fre- 
quently without the application of heat, and with no necessity 
for use of a flux. 

(b) Yes. 

Why is a flux used in soldering metals? Name two 
substances so employed. 

To assist the flowing of solder and metal, and promote 



300 PHYSICS, CHEMISTRY AND METALLURGY. 

their intimate union by preventing oxidation, and dissolving, 
and removing oxides of metals, if formed between opposed 
surfaces. 

Among fluxes we have fused borax, a strong solution of 
zinc chloride. 

In making dental alloy, state the order of fusing the 
metals so that volatilization of the base metal may be 
prevented. 

Melt the highest fusing metal first. Protect its surface well 
with charcoal or borax. Add the other metals in the order 
of their fusing points, the lowest fusing metal being added 
last. 

Give the approximate composition of brass and of Ger= 
man silver. 

Nickel, 10 to 20 parts ) 

Zinc, 20 to 30 parts V Form German Silver 
Copper, 50 to 60 parts ) 

Brass is an alloy of from 60 to 70 parts of copper, with 
30 to 40 parts of zinc. 

Define the term amalgam. 

An amalgam is an alloy of two or more metals, one of which 
is mercury. 

What are the advantages of annealing alloys for dental 
amalgam? Describe the process. 

To reduce brittleness, and again soften the alloy by remov- 
ing the hardness and molecular changes produced in making 
and in cutting the alloy. 

At times, to change the character of the alloy, and to secure 
a uniformity of it. The substances are heated and then al- 
lowed to slowly cool, the process being the inverse of temper- 
ing. Sometimes alloys are annealed by boiling in water. 

In uniting platinum to platinum, what would you use 
as a solder and why? 

Pure gold, for ordinary gold solders do not make a strong 



PHYSICS, CHEMISTRY AND METALLURGY. 301 

joint, and for other reasons are not suitable, while pure gold 
readily alloys with platinum, melts below the fusing point of 
platinum, gives a strong and permanent union, and acquires a 
color like platinum. 

What properties does platinum impart to its alloy with 
gold? 

Elasticity, gives greater strength, increased hardness, in- 
creases the ductility of platinum, lowers the fusing point of 
platinum, gives gold a paler color. 

Describe two different processes for fusing platinum. 

Place it in a cavity in asbestos or magnesium block, through 
which introduce jets of hydrogen and oxygen gases and light. 

Fuse it in electric furnaces between the terminals of the 
electric arc. 

Describe iridium, (a) With what other metal is it 
combined for dental use? (b) What are the advantages 
of these combinations? 

It is a white, lustrous, steel-like metal, slightly heavier than 
platinum, specific gravity of 22.4. It is not acted upon by 
air at ordinary temperatures. It is very hard and brittle 
when cold but becomes malleable at bright red heat. It re- 
quires the oxy-hydrogen name for its fusion. Ordinary acids 
and aqua regia do not act upon it. 

(a) With platinum, to which it gives increased stiffness, 
hardness, and elasticity. 

(b) It also alloys with most metals giving hardness, rigid- 
ity and unalterable character to the alloy, as in certain dental 
instruments. 

J What is arsenic? How is it obtained? Give some of 
its poisonous effects and name antidotes. 

Arsenic is arsenious anhydride, As 2 3 , known commercially 
as "White Arsenic.' ' 

It is obtained from the flues of smelting works that reduce 
ores of many metals, particularly copper, nickel, zinc, and 



302 PHY^CS, CHEMISTRY AND METALLURGY. 

iron, in the ores of which the element arsenicum is generally 
found in combination with sulphur. 

The sweepings froi^ such flues are subjected to sublimation 
when pure arsenic results as a sublimate. 

Arsenic is a gastro-intes^inal irritant and a corrosive poison, 
and produces as characteristic symptoms a sweet, metallic, 
then nauseous taste, with intense burning pain extending from 
fauces to pit of the stomach, accompanied by vomiting and 
great thirst; then follow peculiar nervous symptoms, but 
delirium is absent. 

Chronic arsenical poisoning is shown by white, pasty com- 
plexion, following later by different forms of skin eruptions, 
and anesthetic areas, accompanied by progressive emaciation 
and anaemia and local edemas. 

Antidotes, freshly prepared hydrated sesqui-oxide of iron 
with magnesium. Dialized iron. 

Give a test for arsenic, antimony, gold. 

Reinch's Test for arsenic: — A thin piece of pure copper, 
having a bright metallic surface placed in a strongly acidified 
solution of arsenic becomes, upon heating the solution, coated 
with a dark steel gray deposit of arsenicum, which can be 
vaporized by the application of heat, when combining with 
air. forms as a sublimate octahedral crystals of the tri-oxide, 
which crystals dissolving in water give yellow precipitate 
with ammonio-nitrate of silver solutions ; or green precipitate 
with ammonio-sulphate of copper solutions. 

Test for antimony : — Add hydrogen sulphide to an acidified 
solution of antimony, an orange-red precipitate of the sul- 
phide of antimony forms, which is soluble in solutions of alka- 
line sulphides. 

Test for Gold: — Add hydrogen sulphide to a solution of 
gold: brown auric sulphide is precipitated, which is soluble 
in yellow ammonium sulphide. 

Give a short description of gold and its dental uses. 

It generally occurs native, always accompanied with silver. 
It is usually separated from soil, rocks, etc., by washing with 






PHYSICS, CHEMISTRY AND METALLURGY. 303 

water and amalgamating. It is obtained pure by parting the 
relatively pure gold from silver, copper and other metals by 
the use of acids, or by roasting the impure gold with potas- 
sium nitrate. It is yellow, specific gravity is 19.4, does not 
tarnish in air, nor oxidize directly. It ranks first in order 
of malleability and ductility, and fifth in tenacity. It is not 
as soft as lead but softer than copper. It welds when cold 
and is not dissolved by a single acid, except when heated 
with strong selenic acid. 

In dentistry it is used as foil for filling teeth, when pure for 
soldering platinum, alloyed with copper and silver and plati- 
num it is used as base for artificial dentures. Its elastic 
alloy with platinum is used for clasps and springs. 

What metals are used to alloy gold for clasps and 
springs? 

Platinum, silver, copper. 

Describe a method of (a) refining gold sweepings and 
filings, (b) separating gold from platinum. 

(a) First pass a magnet through the material to remove 
fragments of iron or steel, then melt in a graphite crucible 
with borax and nitre, then alloy the resultant with three times 
its weight of silver and granulate this alloy, then boil these 
granulations in strong sulphuric acid, wash the resulting 
brown powder of gold, melt and cast into ingots. 

(b) Dissolve the alloy of gold and platinum in aqua regia, 
boil off as much acid as possible, dilute with distilled water, 
add ammonium chloride and alcohol, separate the precipitate 
of platinic-ammonic chloride by filtering, add to the filtrate 
ferrous sulphate solution, collect the brown precipitate of 
gold, wash well with dilute hydrochloric acid, then with 
water, dry and fuse with potassium carbonate and mould in 
an ingot. 

Give two methods for refining gold. 

The roasting process: Impure gold is placed in a graphite 
crucible that has been well boraxed. its surface covered with 



304 PHYSICS, CHEMISTRY AND METALLURGY. 

potassium carbonate, it is heated to fusion, when a mixture 
of potassium nitrate and borax is added from time to time; 
after roasting for from one half hour to an hour and a half, 
base metals are oxidized and the resulting refined gold is 
poured into a mould. 

The wet method: Add approximately three times as much 
silver as we have of gold, fuse, cool, roll out and digest in 
nitric or sulphuric acid when heated, when gold, left un- 
dissolved, may be washed, fused and moulded. 

When gold and amalgam are used in approximal cavi= 
ties, which metal has the greater effect on the surround= 
ing dentine? 

Gold. 

State the conditions that generate galvanic currents be= 
tween gold and amalgam fillings, and the conditions under 
which such currents may be avoided. In case of galvanic 
currents, which metal, gold or amalgam, most affects 
the pulp? 

If gold and amalgam fillings be in contiguous teeth so as 
be nearly in contact and there be an acid salivary secretion, 
galvanism may occur. Currents may be avoided by not 
bringing different metals close together, by neutralizing acid 
saliva, and by selecting metals for the amalgam that are 
not widely different in their electric potential conditions 
from gold. 

Under the influence of galvanism gold affects the pulp most. 

Why do we find the quality of cohesiveness more marked 
in gold than in silver, copper and lead? 

Because gold metal is of a closer texture than the others, 
having a fern-like interlacing crystalline structure. It does 
not oxidize directly, and is probably not volatile. It has the 
power of welding when cold, and surface absorption of gases 
is readily removed by heating. 

What does the term " carat " signify? 

The term "carat" refers to the proportionate amount of 



PHYSICS, CHEMISTRY AND METALLURGY. 305 

pure gold in a gold alloy. Thus pure gold is said to be of 
24 carat, while 18-carat gold is composed of 18 parts of pure 
gold, and 6 parts of alloying metal. 

How do you find the carat? 

By using the following proportion example: As the weight 
of the alloyed mass is to the weight of gold it contains, so is 
24 to the standard sought. 

Or, make use of a touch-stone with its accompanying gold 
points of different degrees of purity, employing the cus- 
tomary acids. 

gold 6 \ 
What carat would silver 2 v be? 

copper i j 
9 : 6 : : 24 : X ; X=16. Ans. 

How do you reduce from higher to lower carat? 

Add to the gold of higher carat copper or silver or both, 
employing the following proportion example to obtain the 
required quantity of alloying metal. As the required carat 
is to the carat used so is the weight used to the weight of the 
alloyed mass when reduced — when, the weight of the mass 
used subtracted from this will give the quantity of alloy to 
be added ; example ; Reduce 4 oz. of 20-carat gold to 16-carat. 
16 : 20 : : 4 oz. : X=5 oz. and 5 oz. — 4 oz.= 1 oz alloy to be 
added. 

How do you raise gold from lower to higher carat? 

Add pure gold or a gold alloy richer in gold than the one 
to be raised. 

Rule: As the alloy in the required carat is to the alloy in 
the given carat so is the weight of the alloyed gold to the 
weight of the reduced alloy required, then the weight of the 
alloyed gold used, subtracted from this, gives the amount of 
pure gold to be added. 

Example : Reduce one dwt. of 16-carat gold to 18-carat 1 

First subtract both 16 and 18 from 24 to find the alloy in 
20 



306 PHYSICS, CHEMISTRY AND METALLURGY. 

each carat, then 6 : 8 : : 1 dwt. : X.=iy s dwt, then 1% dwt. 
—1 dwt=% dwt. pure gold to add. 

Describe the process of alloying pure gold to make it 
suitable for 20=carat base plate, (b) State the propor= 
tion of each ingredient metal. 

Anneal a plumbago crucible while held inverted, then add 
the metals, on top of which place a small quantity of pow- 
dered charcoal, cover crucible with lid. Heat to a bright red 
heat and when melted stir with a red-hot iron rod, pouring 
as soon as possible after fusion. Grease the ingot mould 
and cast the metal, and then roll and hammer into sheets. 

(b) Pure gold, 20 dwt; copper, 2 dwt; silver, 1 dwt; 
platinum, 1 dwt. 

How would you distinguish a bar or a plate of tin from 
a metal similar in appearance? 

By its producing a creaking noise when bent, which is 
known as the "tin cry," and is due to the crystalline char- 
acter of the interior of the metal bar. 

Mention a solvent for gold and platinum. Give for= 
mula. 

. Aqua Regia; 3HC1+HN0 8 =2H 2 0+N0C1+C1 2 . 
Or, 3HC1+HN0 3 =2H 2 0+N0C1 2 +C1. 

State the chemical action that causes teeth clasped with 
gold to decay beneath the gold more quickly than those 
clasped with rubber. 

The gold clasp causes more attrition of tooth structure, fits 
less snugly allowing space for accumulation of material and 
its subsequent decomposition, with accompanying bacterial 
activity, while the rubber clasp, slowly parting with sulphur, 
gives constantly germicidal and antiseptic protection from 
the sulphur dioxide that is formed. 

Explain how pure gold can be obtained from mixtures, 
alloys, and solutions containing gold and other substances. 

- If 'material is liquid evaporate until dry, then, first re- 



PHYSICS, CHEMISTRY AND METALLURGY. 307 

move iron and steel by magnet ; second, roast in well boraxed 
crucible with potassium nitrate and cast in ingot; third, re- 
melt, fusing with three times its weight of silver, and granu- 
late this alloy; fourth, boil these granulations in sulphuric 
acid, wash, then dissolve in aqua regia, precipitate platinum 
by adding ammonium chloride and alcohol, then to the liquid 
add ferrous sulphate, wash the resulting precipitate in hydro- 
chloric acid, then in water, melt with potassium carbonate, 
and mould in greased ingot mould. 

Name several metals which readily impair or destroy 
the malleability and ductility of gold. 

Tin, lead, antimony, bismuth, arsenic. 

Give the physical properties of silver, and state its most 
important salt. Define the use in dentistry of silver. 

It is the whitest of metals, is brilliant and next to gold, 
most ductile and malleable. Is harder than gold, not so hard 
as copper. Fuses at 1904° F., has a specific gravity of 10.4. 
It is the best conductor of heat and electricity, volatile at full 
red heat, its vapor is blue. When fused it absorbs oxygen, 
which escapes as the metal cools, causing a roughened surface. 
Is not acted upon by pure air or moisture, but combines di- 
rectly with sulphur, phosphorus, or chlorine. 

Its most important salt is argentic nitrate AgN0 3 . 

Use of silver in dentistry : Alloyed with platinum forming 
dental-alloy, it is used for making base for artificial dentures 
and for crown and bridge work. It, with tin, constitutes the 
two essential metals in all good dental amalgam alloys. An 
alloy of silver, copper and platinum is often used for base 
-plate. Silver enters largely in the composition of dental 
solders. 

Describe a method of obtaining silver from one of its 
native ores. 

Amalgamation Process for silver sulphide reduction: 
Ore is crushed and roasted with common salt at dull red 
heat, when silver chloride and sodium sulphate result, 



308 PHYSICS, CHEMISTRY AND METALLURGY. 

This mixture is placed in barrels with water, scrap iron, and 
mercury, and the barrels rotated, when ferrous chloride and 
metallic silver result — the metal silver at once amalgamates 
with the mercury, and this amalgam, from its greater weight, 
sinking below the dross, is run off, squeezed in bags until 
solid, and distilled in iron retorts, when the mercury is re- 
covered and the silver, more or less impure, is left in the 
retort. This impure silver may then be mixed with lead and 
heated in a cupel furnace when silver of a fair degree of 
purity is obtained. 

Describe silver nitrate and give its chemical formula. 

Silver nitrate, formula AgN0 3 , crystallizes in colorless, 
right rhombic plates, soluble in its own weight of water, turns 
black on contact with organic matter, fuses readily unchanged 
and can be cast in moulds and in this form the impure salt is 
known as "Lunar Caustic." It is a corrosive and irritant 
poison, its antidote is common salt, or a soluble chloride. 
It is astringent, alterative, and caustic in action. 

Explain the chemical process for recovering pure silver 
from refuse amalgam. 

Heat the amalgam at red heat for some time to get rid of 
as much mercury as possible, then granulate and dissolve 
the metal in 50% strength nitric acid; decant from any in- 
soluble residue, and, to the clear liquid, add solution of 
sodium chloride. Wash the resulting precipitate of silver 
chloride, place it in a clean beaker with twice its bulk of dis- 
tilled water, acidulate the liquid with sulphuric acid and in 
it place pure iron, as in the form of nails. Stir this mixture 
and when the precipitate becomes of a uniform gray color 
remove the iron, filter, wash the precipitate with well diluted 
hydrochloric acid, and then with water. Dry the gray de- 
posit and fuse in a crucible that has been boraxed, with potas- 
sium carbonate, and when melted pour in an ingot mould. 

What salt of silver is used in dentistry? Give its for= 
mula. 

Silver nitrate. Its formula is AgN0 3 . 



PHYSICS, CHEMISTRY AND METALLURGY. 309 

Would you use silver in making plates? Why? 

No. From its softness and flexibility and its affinity for 
sulphur it is unfitted for plates when pure. When alloyed 
with platinum, it is used as a base for artificial dentures. It 
is generally alloyed with gold for use in dentistry. 

Mention the chief source of sodium. Give the principal 
reactions of sodium. 

Sodium occurs most abundantly as the chloride, existing 
as such in animal, vegetable and mineral structures. The 
metal sodium is generally obtained by distilling sodium car- 
bonate and charcoal in iron retorts. Sodium or its compounds, 
when heated in the inner Bunsen flame color the outer flame 
yellow. Its compounds are, in nearly all instances, soluble 
in water. 

(a) What is sodium silicate? (b) Mention the use of 
sodium silicate in dentistry. 

Sodium silicate, Na 2 Si0 3 , is known as soluble glass and is 
obtained by strongly heating equal weights of sodium carbon- 
ate and sand, and dissolving the resultant in boiling water, 
this yielding a solution of sodium silicate in water. 

(b) Is applied to bandages when, on drying, forms a per- 
fect cast of the part so that such stiffened bandage when cut 
and removed may be used as a splint, as in fracture of the 
jaw. 

Mention the properties and give the composition of 
cast=iron. 

Cast-iron is gray in color, brittle, melts at much lower 
temperature than wrought iron, contracts but little on cool- 
ing from fusion, is hard, has been used for dies for dental 
purposes. 

Its composition varies but it usually contains from 2 to 
4% of carbon, two-tenths to three per cent, of silicon, less 
than 2% of manganese and small quantities of sulphur and 
phosphorus. 



310 PHYSICS, CHEMISTRY AND METALLURGY. 

Name three salts of iron and place the chemical for- 
mula after each. 

Ferric chloride, Fe 2 Cl 6 ; ferric sulphate, Fe 2 3S0 4 ; ferrous 
sulphate, FeS0 4 . 

Illustrate by symbols (formulae) the decomposition of 
(a) water by potassium, (b) sulphuric acid by iron. 

(a) 2H 2 + K 2 = 2KOH + H 2 . 

(b) 2H 2 S0 4 + Fe 2 = 2FeS0 4 + 2H 2 . 

What salt of iron is used as an antidote for arsenic 
poisoning? State how this salt may be rapidly prepared. 

Freshly prepared hydrated sesqui-oxide of irou with mag- 
nesium. This may be obtained by adding to any ferric salt 
of iron, like ferric sulphate in solution, calcined magnesia; 
or by adding ammonia water to the solution of iron salt, and 
quickly washing the precipitate with water, squeezing it 
in a rag. 

By what simple treatment can a hard steel instrument 
be softened? How may softened steel be again hard- 
ened? 

Soften a hard steel instrument by heating to about a cherry 
red heat and then allowing it to cool slowly. 

To harden steel heat it to redness and cool very quickly, 
as by plunging in cold water. 

Describe the method of tempering steel instruments. 

The instrument is first heated red hot, then plunged in 
water. It is then placed in a sand bath, leaving but a minute 
point of the instrument exposed to view; heat is then 
gradually applied to the sand bath until the desired temper- 
ature, generally less than 500° F., indicated by the color that 
the instrument assumes, is reached, when the instrument is 
cooled quickly by immersing in water, acid, or oil. 

What do you know about mercury as a metal? 

It is the only metal liquid at ordinary temperatures, and 
is silver white. Specific gravity is 13.6, it does not tarnish 



PHYSICS, CHEMISTRY AND METALLURGY. 311 

in air, it dissolves all metals except iron, forming amalgams. 
Is soluble in acids. 

How are the impurities of mercury detected and how 
readily removed? 

A globule of pure mercury should be round. If it assumes 
an elongated shape or leaves a mark as it passes over a smooth 
white surface, or if it undergoes oxidation at ordinary tem- 
peratures in air, it is impure. To purify, distil mercury after 
covering its surface with iron filings ; or, add to mercury nitric 
acid and after contact for 24 hours, pour off the liquid and 
wash the mercury with water. 

Name some of the metals for which mercury possesses 
a great affinity. 

Tin, gold, silver, lead, zinc, copper. 

Mention the important ore of mercury and describe the 
process by which the metal is obtained from this ore. 

Cinnabar, HgS. 

This ore is heated in a kiln or furnace to which are con- 
nected large condensing chambers into which S0 2 gas and 
mercury vapor pass, the latter condensing. 

The metal so obtained needs purifying, to remove from it 
other metals usually contaminating it. 

Describe the properties of copper amalgam. Name some 
of its advantages and disadvantages. 

Obtained by direct union or, preferably, by electrolytic 
deposition. 

At first soft and plastic, after a few hours standing be- 
comes hard and crystalline, but may be again softened on 
heating. 

Though hard, it is malleable, can be polished, retains its 
lustre in air, but darkens on contact with sulphuretted hy- 
drogen. Does not expand on hardening. 

Advantages of copper amalgam: Such fillings retain good 
margins, are very hard and rigid, do not contract, but slightly 
expand on setting and perfectly seal the cavity. 



312 PHYSICS, CHEMISTRY AND METALLURGY. 

Exerts beneficial effect on tooth structure. 
Disadvantages : Becomes bluish-black, undergoes surface 
disintegration. 

Name and describe two salts of mercury and give the 
formula of each. 

Calomel, or mild chloride of mercury, or mercurous chloride. 

A white amorphous powder sublimes without fusing, in- 
soluble in water and alcohol, used as a mild laxative in single 
dose of 10 grs., is not poisonous, formula Hg 2 Cl 2 , or HgCl. 

Corrosive sublimate, corrosive chloride of mercury, mer- 
curic chloride, bichloride of mercury : It is a white crystalline 
salt, soluble in water, alcohol and ether. It is a corrosive. and 
highly poisonous substance, one twenty-fourth of a grain con- 
stituting a large single dose. It is extensively used as an 
antiseptic, when in solution in 2000 to 5000 parts of water. 
Used internally as an alterative. Its formula is HgCl 2 . 

State some of the general uses of mercury, (a) How 
may it act as an irritant poison? (b) What precautions 
should be observed for safety? 

Used in construction of thermometers, barometers, mano- 
meters, to measure the capacity of vessels, its amalgam with 
tin or silver used to make mirrors, used to amalgamate zincs 
of a battery, used finely divided as with chalk in medicine. 

(a) In finely divided state it may form soluble salts of 
poisonous nature, as mercuric chloride, from the action upon 
it of hydrochloric acid in gastric juice, or may produce or- 
ganic compounds of a soluble nature, or its vapor, constantly 
inhaled, may occasion a form of chronic poisoning from its 
ready conversion into mercurial compounds. 

(b.) Obtain perfect cleanliness after its use, thorough ven- 
tilation in rooms in which its vapor escapes, if the slightest 
symptoms of ptyalism appear, stop any further ingestion of 
the substance and use astringent mouth washes, take inter- 
nally potassium iodide to facilitate the elimination of mercury 
from the system. 



PHYSICS, CHEMISTRY AND METALLURGY. 313 

State the conditions under which amalgam would be 
improved by washing. 

When the there are present oily or fatty matters or dirt, 
from manipulation in the hand, or oxides or other metallic 
salts accidentally produced, washing amalgam in water, al- 
cohol, ether or chloroform has been recommended. 

Distinguish between the effects produced upon pulps by 
(a) inserting in the same cavity a compound filling of 
gold and amalgam, (b) filling approximal cavities, one 
with gold and the other with amalgam. Give reasons for 
the different effects. 

(a) If the compound filling be perfect, so that no fluid reaches 
its interior, no galvanic action takes place, and the tooth pulp 
is preserved. If on the other hand fluid penetrates the filling, 
galvanic action takes place leading to destruction of the pulp. 

(b) If the two fillings are in contact at any point galvanic 
action will occur, should the saliva become acid, and lead to 
a destruction of the pulp most marked in the tooth filled 
with gold. 

Describe the chemical process involved in the setting 
of amalgam. 

When an amalgam has been produced the mercury at once 
begins to combine chemically with the metal or metals pres- 
ent. That this combination is a chemical one is shown by the 
occurrence of crystallization, the evolution of heat, and the 
extruding or forcing from the solidifying mass of the excess 
of mercury. 

What important properties should amalgams for filling 
cavities in teeth possess? 

A permanency of form, hard, dense and sufficiently tough 
to resist attrition, with edge strength and sharpness of edge, 
should offer perfect resistance to oral secretions and food, and 
be free from any metal that would favor the formation of 
injurious soluble salts, and should retain a good color. 



314 PHYSICS, CHEMISTRY AND METALLURGY. 

Describe (a) negative metallic fillings, (b) positive 
metallic fillings. 

A negative metallic filling would be one containing such 
metals as are weakest in their ordinary electro-positive con- 
ditions, while the positive metallic filling would be formed of 
the strongest electro-positive metals; thus, if we make a list 
of metals like Au, Pt, Pd, Sb, Hg, Ag, Cu, Bi, Pb, Ni, Fe, Sn, 
Cd, Zn, Al, such fillings containing metals from the last half 
would be positive fillings while those composed of metals 
selected from the first half would form negative fillings. 

By what chemical tests is the presence of lead recog= 
nized in solution? 

Hydrochloric acid gives a white precipitate of lead chloride 
soluble in boiling water. 

Hydrogen sulphide gives a black precipitate of lead sul- 
phide insoluble in ammonium sulphide. 

Sulphuric acid gives a white precipitate of lead sulphate. 

Potassic chromate gives yellow lead chromate. 

Alkaline carbonates give white precipitates with lead of 
basic carbonates. 

How is aluminum obtained? Give its symbol and 
atomic weight. 

By heating in reverberatory furnace, ten parts of double 
chloride of aluminum and sodium, five parts of double fluoride 
of aluminum and sodium, and two parts of metallic sodium; 
or, by the electrolysis of a fused aluminum ore. 

Symbol is AL Atomic weight is 27. 

(a) Describe the general properties of aluminum, (b) 
How is it employed in dentistry, (c) Why is its use 
limited? 

(a) It is almost as white as silver, is but two and one-half 
times the weight of water, is not acted upon by air, even where 
hydrogen sulphide is present, and so does not darken on ex- 
posure like silver, is extremely malleable, and ductile, is very 
sonorous, is a good conductor of heat and electricity, melts at 
about 1150° F., is not acted upon by the vegetable acids, dis- 



PHYSICS, CHEMISTRY AND METALLURGY. 315 

solves in solutions of caustic soda or potash, and in hydro- 
chloric acid. 

(b) Is used as a base in connection with rubber or celluloid 
by which the teeth are attached — an alloy of copper and 
aluminum has been used as a base. Many dental appliances 
(trays, instruments, etc.) may be made of aluminum. 

(c) Its use is limited because of its ready solubility in 
alkaline solution, its great contraction after cooling, the diffi- 
culty of soldering it, the readiness with which it oxidizes 
when finely divided as in amalgams, and its attendant enor- 
mous swelling and marked chemical action. 

Why cannot amalgam of aluminum and mercury be 
employed to fill cavities in teeth? 

Aluminum amalgam is unsatisfactory from the readiness 
with which oxidation takes place, its great expansion on set- 
ting, marked chemical action that occurs on amalgamating, 
liberation of much heat. 

What are the chemical and physical properties of 
asbestos? 

Asbestos, or amianth, is a fibrous silicate of calcium and 
magnesium, the length of the fibres being from less than one 
inch to five feet. A single fibre can be fused, but any 
considerable collection of fibres is practically infusible. It 
is a bad conductor of heat, it is unaffected by acids, may be 
woven into cloth. Is used as covering to prevent radiation, 
as from flues, and to prevent communication of heat to com- 
bustible substances, for filtering strongly acid liquids, etc. 

Mention two important ores of zinc, and describe the 
process by which the metal is obtained from one of the 
ores. 

Calamine or native carbonate, ZnC0 8 . 

Zinc blend, ZnS. 

Calamine is first roasted in air, forming zinc oxide and C0 2 
gas. The zinc oxide is then mixed with charcoal or coke, in 
earthenware retorts, and is subjected to downward distillation. 
when the vapor of the metal solidifies, yielding zinc. 



316 PHYSICS, CHEMISTRY AND METALLURGY. 

Write the equation showing the reaction of (a) hydro= 
chloric acid on zinc, (b) Sulphuric acid on zinc. 

( a) Zn 2 + 4HC1 = 2ZnCl 2 + 2H 2 . 

(b) Zn 2 + 2H 2 S0 4 = 2ZnS0 4 + 2H 2 . 

Give the properties of metallic zinc and state its uses 
in dentistry. 

It is a bluish white metal, melts 779° F., specific gravity 
6.9, is brittle and crystalline. When heated to 212° to 302° 
F. becomes ductile and malleable, retaining its malleability 
after cooling. When heated to 400° F., it again becomes 
brittle so that it can be powdered. It is volatile, and on 
heating, burns to form the oxide of zinc. It contracts mark- 
edly on cooling after heating, is harder than gold or silver, 
does not oxidize in air or moisture at ordinary temperatures. 

Used in dentistry for making dies for swaging metal plates, 
less often is used to make counter-dies. It is often a con- 
stituent of solders, and in the form of brass is frequently 
added to gold in making solder. Its oxide, chloride, and sul- 
phate enter into the composition of dental cements. Zinc 
chloride is used in dentistry as a disinfectant and obtunding 
agent. Its sulphate is astringent and emetic. Zinc is often 
added to alloy amalgams. 

Distinguish chemically between oxy=chloride of zinc 
and phosphate (oxy=phosphate of zinc). State the con= 
ditions indicating the use of each in dentistry. 

The liquid used in oxy-chloride of zinc cement is a solution 
of one oz. zinc chloride dissolved in 5 or 6 drams of water; 
the powder is calcined pure zinc oxide with a small amount 
of borax and silica added. 

The liquid used in oxy-phosphate of zinc cement is made by 
evaporating a solution of glacial phosphoric acid in water to 
a syrupy consistency : the powder is pure calcined zinc oxide. 

Oxy-chloride of zinc cement is not permanent, sets slowly, 
shrinks markedly, is antiseptic, and is used for filling, lining, 
and restoring color to teeth. Oxy-phosphate of zinc cement 
is more permanent, lasting from two to seven years and is 
les3 irritating. 



HISTOLOGY. 



By what tissues are nerve fibers held together? 

In the central nervous system, nerve fibers are held to- 
gether by neuroglia. This consists of branched cells, con- 
nective tissue in function, though epiblastic in origin. 

In peripheral nerves, the fibers and bundles of fibers are 
bound together by true connective tissue sheaths. That 
covering the nerve is called the epineurium ; that surrounding 
the bundles of nerve fibers is the perineurium; uniting the 
fibers in the bundle are extensions from the perineurium, the 
endoneurium. These consist of bundles of ordinary connec- 
tive tissue fibers. 

What tissues are derived from the para=blast? 

The para-blastic tissues include those usually spoken of as 
mesodermic, except the endothelial cells and the smooth 
muscle fibers (see page 340, Q. "What tissues are derived 
from the mesoblast?"). 

Mention the nourishing fluids of the body. 

The blood and the lymph. 

Describe the blood platelets. 

These elements are very unstable when blood has been 
drawn, and therefore not easily demonstrated in the ordinary 
preparation. They occur, nevertheless, as round, flattened 
bodies. They are colorless and have an average diameter 
of one-third that of a red blood corpuscle. Their function 
though not definitely understood seems to be in relation with 
the phenomenon of coagulation of the blood. 

(317) 



318 HISTOLOGY. 

Describe a method of hardening tissues for microscopic 
sections. 

The tissues to be examined should be removed as freshly as 
possible from a recently killed animal and cut into pieces not 
more than two cm. in thickness. They should then be placed 
in a "fixative," such as absolute alcohol or Miiller's fluid; the 
latter should be changed as soon as it becomes cloudy. Alco- 
hol is more rapid in its action; small pieces can be fixed in a 
few hours, while Miiller's fluid requires at least two weeks. 

After fixation the tissues are hardened in increasing 
strengths of alcohol, beginning at eighty per cent, then ninety- 
five, and finally absolute alcohol. The tissue is now ready 
for infiltration with a suitable material which will give dens- 
ity, thus aiding in the cutting. Either paraffin or celloidin 
may be used. 

The tissue must now be placed in a solvent of the substance 
used for infiltration. If celloidin be used, the solvent 
is equal parts of alcohol and ether. In this (A & E) 
the tissue should remain several hours (12-24), then in a solu- 
tion of thin celloidin for an equal length of time. Following 
this the tissue is placed in thick celloidin, allowing it to re- 
main for a sufficient length of time to permit an infiltration 
of the tissue with celloidin. It is finally mounted on a block, 
surrounding the tissue with a layer of thick celloidin which 
hardens when exposed to the air. The block and tissue should 
then be kept in eighty per cent, alcohol until ready for cutting. 

What is fibrin? 

As the name implies, it is a substance, fibrous in nature, 
which is formed during the process of coagulation of the 
blood. It is produced by the fibrin-forming principles, fi- 
brinogen and fibrin ferment. Fibrin appears in the form of 
very delicate, interlacing, straight threads. These occupy a 
position between the blood corpuscles; sometimes they seem 
to radiate from a common center. 

State the function of cilia. 

Cilia occur upon surfaces in localities in which fluids are 



HISTOLOGY. 319 

to be propelled or foreign bodies removed, e. g. mucous mem- 
brane of the respiratory tract. 

Describe the intercellular constituents of connective 
tissue. Describe one variety. 

These may be said to consist of two elements, fibers and the 
matrix. The fibers may be in the form of delicate white 
connective tissue threads, formed probably at the expense of 
the cellular elements, placed parallel without anastomosis ; or, 
the fibers may be yellow, highly refractile, anastomosing 
threads. The matrix of connective tissue gives to it its char- 
acter, varying in density in the several tissues. In mucous 
or embryonic tissue it is colorless, transparent, gelatinous. 

Describe the microscopic appearance of pavement epi= 
thelium. 

This variety consists of a single layer of cells held together 
by a small amount of intercellular cement substance. "When 
viewed from the surface it presents the appearance of a 
mosaic. The cells are usually squamous in shape. 

Define marginal zone. 

This term is applied to the striated border seen at the 
free margin of some cells, notably the epithelium in the 
small intestine. 

Describe the development of elastic fibrous tissue. 

In the elastic connective tissue the fibers are formed in 
the matrix, probably at the expense of the connective tissue 
cells. In the beginning, rows of chain-like arrangements of 
granules are seen. Subsequently, these granules become 
fused, forming branched elastic fibers. 

Describe Peyer's Patches. 

These are masses of small round cells (lymphoid) in a 
connective tissue reticulum, situated in the sub-mucous and 
mucous coats of the lower part (ileum) of the small intestine. 
They are also known as agminate glands. 



320 HISTOLOGY. 

Describe the process by which osteoblasts are converted 
into bone cells. 

Osteoblasts are the cells active in the production of osseous 
tissue. During the process the osteoblasts soon become en- 
veloped in the bone matrix, occupying minute spaces — the 
lacunae. The cells, having ceased their action in the pro- 
duction of bone, become bone cells. 

Describe the structure of the mucous membrane lining 
the oral cavity. 

An epithelial covering, of the stratified squamous variety, 
and a connective tissue base form the essential structural ele- 
ments. The outer layer of cells is flattened and scale-like; 
the deepest layer is of columnar cells, sometimes named the 
Malpighian layer; the intervening layers are of polyhedral 
cells. The connective tissue portion is the tunica propria, 
upon which rests the epithelium. It consists of somewhat 
densely arranged, white fibrous connective tissue in which 
are carried blood vessels, nerves and lymphatics. Projections 
of the tunica propria upward into the epithelium carry the 
terminal vessels and nerves. These projections are termed 
papillae and are best developed on the tongue and gums. 
Down-growths of the epithelium into the connective tissue 
are arranged in the form of sacs, clusters of which unite 
with a common duct. These are mucous glands, the ducts 
of which open on the surface of the mucous membrane. On 
the gums the epithelial layer of the mucous membrane is 
very thin. This accounts for the readiness with which the 
gums bleed. On the hard palate, the mucous membrane is 
thin and tightly adherent to the periosteum. 

State where marrow is found. Describe the varieties 
of marrow. 

Marrow is found in the interior of bone ; in the medullary 
canal in the shafts, and at the extremities of long bones; 
also in the interior of the flat and irregular bones. Varia- 
tions in marrow are noticed in bones at different ages and 
also in different anatomical locations. In the cavities of long 



HISTOLOGY. 321 

bones, in adult animals, the marrow is yellow, due to the ac- 
cumulation of fat within it. The marrow of all bones in 
young animals is red, because of the great number of red 
blood corpuscles. The extremities of long bones (adult) also 
contain red marrow. 

Red marrow consists of (a) marrow cells, or myelocytes, 
which resemble leucocytes, though larger, containing rather 
large nuclei. In the protoplasm of the cells are formed 
granules which stain with neutral stain, thus distinguishing 
them from mono-nuclear leucocytes. (b) Nucleated red 
blood corpuscles are formed in the marrow. They later 
loose their nuclei before entering into the circulation, (c) 
Cells, the protoplasm of which stains deeply with eosin; some 
of these cells are mono-nuclear, others are polymorpho- 
nuclear, (d) Leucocytes and lymphocytes, (e) Giant cells 
(myeloplaxes) which are large cells, polynu clear as a rule, 
and are the osteoclasts of bone development. 

Yellow marrow contains few cells, an appreciable amount 
of areolar tissue containing fat. 

Describe the method of cutting tissues for microscopic 
section. 

Good sections may be cut by hand with a razor ground flat 
on one side, but the best result may be had by use of the 
microtome. For celloidin sections, the razor is arranged obli- 
quely so that a long stroke may be made, using as much of 
the edge of the knife as is possible in cutting each section. 
The tissue block, held in a suitable clamp, is kept wet with 
eighty per cent, alcohol ; the knife should also be kept flooded 
with alcohol, so that the sections can easily be straightened 
without tearing them. 

For paraffine-embedded tissue, the sections are cut dry. and 
removed from the knife with a camel's-hair brush. 

Describe the cellular elements of connective tissue. 

The cells of connective tissue vary in shape with the variety 
and age of the tissue. The youngest cells occur in greatest 
number and more closely arranged than the older cells in the 
21 



322 HISTOLOGY. 

intercellular substance. Connective tissue cells may be round, 
oval, spindle-shaped, stellate; in the last instance they bear 
delicate protoplasmic prolongations, which interlace. In 
areolar tissue are found round and oval cells, fixed cells; 
wandering cells resembling leucocytes. Tendons contain flat 
cells arranged in lamellae between the bundles of fibers. 
Cartilage contains spindle and angulated cells, the latter be- 
ing the older. Bone cells are irregular in shape. They 
have delicate processes which lie in canaliculi. 

Describe the microscopic appearance of columnar epi= 
thelium. 

Columnar epithelium may be simple or stratified. The cells 
are cylindrical in shape ; the nucleus, usually oval, is situated 
at the base of the cell which rests on end upon the supporting 
membrane. When several layers of cells exist, it is only the 
superficial layer which has its cells distinctly columnar. The 
deeper cells are irregularly columnar or polyhedral. Colum- 
nar epithelium may or may not be ciliated. 

State how spongy bone is converted into compact bone. 

This is accomplished by the absorption of spongy bone, 
which thereby forms in it large oval spaces, the Haversian 
spaces, within which new formation of bone takes place. The 
bone cells deposit, layer by layer, new bone, until a narrow 
canal, the Haversian canal, remains instead of the former 
space. 

Describe fibro=cartilage. 

This variety consists of a hyaline matrix in which are em- 
bedded cartilage cells and fibers. The cells usually occur in 
groups of two or three in a lacuna, surrounded by a zone of 
clear matrix. Throughout the remainder of the matrix are 
arranged delicate fibrils of white fibrous tissue. The trans- 
formation of hyaline cartilage into fibro-cartilage is well de- 
monstrated at the attachment of the ligamentum teres to the 
head of the femur. Here the fibers of the ligament extend 
into the hyaline matrix of the articular cartilage. Fibro- 
cartilage is without a distinct perichondrium. 



HISTOLOGY. 323 

Describe the development of cartilage. 

Cartilage grows from the inner or chondrogenic layer of the 
perichondrium which consists of spindle-shaped connective 
tissue cells. The cells produce the matrix, depositing it in 
layers beneath this membrane. As the cartilage grows, the 
cells remain in small spaces, lacunae, within the matrix, be- 
coming larger and rounded as the age of the tissue advances. 
The youngest cartilage cells are spindle-shaped, arranged in 
rows immediately beneath the perichondrium. 

Describe the reticulum of lymphoid tissue. 

The reticulum of lymphoid tissue consists of an interlace- 
ment of bundles of white fibrous connective tissue, loosely 
arranged. Upon the bundles, particularly at their junctions, 
occur flattened, or stellate connective tissue cells. It is in 
this reticulum that the cells of the lymphoid tissue occur. 

Describe myxomatous tissue. 

This tissue is the youngest form of connective tissue. It 
consists of a jelly-like, transparent, homogeneous matrix in 
which are arranged stellate connective tissue cells, which 
have delicate protoplasmic prolongations. The branches 
frequently anastomose, forming a delicate reticulum. 

\ Describe Nasmyth's membrane. 

This structure is the remains of the enamel organ. As the 
tooth becomes larger the deepest layer of cells is forced 
toward the superficial layer. The intervening layers atrophy 
and thus the enamel organ becomes reduced to a thin mem- 
brane which invests the crown of the tooth. This membrane 
persists for a short time only after the tooth has been 
erupted, soon wearing away as the result of friction. 

Describe the microscopical appearance of adipose tissue. 

This tissue consists of a delicate reticulum of white fibrous 
connective tissue, containing comparatively large interstices 
in it. In the spaces are to be seen cells the protoplasm of 
which has been displaced, the cell wall distended and occu- 
pied by fat. The nucleus of the cell is pushed to one side, 



324 HISTOLOGY. 

being displaced by the globule of fat. The fat cells are usu- 
ally in groups surrounded by areolar tissue ; a rich blood sup- 
ply is found in this tissue. 

Give the microscopic appearance of non=medullated 
nerve fiber. 

Such a nerve fiber is distinguished from the medullated 
nerve fiber by the absence of the medullary sheath. It con- 
sists of an axis cylinder and a neurilemma; the fibers branch 
freely previous to their termination which is not true of 
medullated nerve fibers. The axis-cylinder is distinctly 
fibrillated. Nuclei are numerous, being irregularly placed 
along the course of the fiber, lying beneath the neurilemma. 

What are lacunae? 

Lacunae are spaces found in compact connective tissue, such 
as cartilage and bone (cementum). They contain the cells 
of the particular tissue and also lymph. In bone they com- 
municate with one another by means of minute capillary- 
like channels, called canaliculi. 

Describe the structures composing the heart. 

Pericardium, which covers the heart and forms a closed 
sac is a serous membrane, consisting of a single layer of 
endothelial cells, resting upon a basement membrane of fibro- 
elastic connective tissue. 

The myocardium, or the muscular tissue of the heart, forms 
the bulk of the organ. It consists of a dense net-work of 
branching muscle fibers nucleated and without a sarcolemma. 
The fibers are short, cylindrical in shape, grouped together 
in bundles, united by connective tissue. On the surface of 
the muscle the connective tissue blends with that of the 
pericardium. 

The endocardium, the lining of the heart cavities, is a 
serous membrane, with a single layer of endothelial cells rest- 
ing on a connective tissue base. It is continuous with the 
intima of the blood vessels. At the orifices of the heart cham- 
bers the endocardium presents reduplications, to form the 



HISTOLOGY. 325 

heart valves which are re-enforced with bands of fibrous 
connective tissue. 

Mention the tissues derived from the hypoblast. 

The epithelium of the digestive tract and the associated 
glands, except the oral cavity and its glands; the epithelium 
of the respiratory tract ; urinary bladder and the urethra ; 
ureters; epithelium of the thyroid body and thymus (Hassal's 
corpuscles) ; Eustachian tube and middle ear. 

Give the location of stratified epithelium. 

Squamous : 

Oral cavity — pharynx, oesophagus, epiglottis, — true and 
false vocal cords, epidermis, cornea, external auditory canal, 
vagina, female urethra, beginning and end of male urethra, 
urinary bladder, ureters, pelves of the kidneys, (transitional 
epithelium) . 

Columnar (non-ciliated) : 

Olfactory, part of the nasal fossae, part of vas-deferens. 

Columnar (ciliated) : 

Eustachian tube, part of tympanic cavity, lachrymal pas- 
sage, respiratory part of nasal fossae, ventricle of larynx, 
trachea and bronchi, epididymis and the first part of the 
vas-deferens. 

How do nerve fibers terminate? 

Before reaching its termination a nerve fiber loses its 
myelin sheath; next, its neurilemma, and continues for a 
short distance as a naked axis-cylinder; these break up into 
fibrillae and terminate as general free endings. 

Nerves may also end in special nerve endings, as in tactile 
cells or tactile corpuscles or end bulbs. 

Motor endings in muscle are in the form of inter-muscular 
plexuses, which ultimately become naked axis-cylinders, and 
these in turn break up into fibrillae and terminate in motor 
end plates. 

Describe the perforating fibers of Sharper. 

These are transversely placed fibers occuring in the super- 



326 HISTOLOGY. 

ficial lamellae of bone and represent extensions of periosteum 
which have not undergone calcification. 

They are found most numerous in spongy bone and in the 
interstitial lamellae of compact bone. 

Describe the centers of ossification. 

In the development of bone, particularly enchondronal 
bone, are found areas in which the first changes in the bone- 
forming process take place. ' These areas are the so-called 
centers of ossification. 

The cartilage cells multiply and increase in size, becom- 
ing separated from one another by an increase in the inter- 
cellular substance and finally are arranged in vertical rows. 
It is here that the first deposition of calcareous substance 
takes place, and is known as the ' ' primary areola of Sharpey. ' ' 

(a) What are giant cells? (b) Give their function. 
(c) What will cause their action to cease? 

(a) Giant cells are large, multi-nuclear cells found in bone 
marrow. (See answer to question, " Describe varieties of 
marrow," page 320). 

(b) Their function is that of bone resorption. 

(c) Isolation by osseous tissue will cause their action to 
cease. 

Describe the ossification of the alveolar process. 

Before birth, the alveolar process presents on its superior 
margin a deep longitudinal furrow which corresponds to the 
future tooth sockets, and in which are contained the develop- 
ing temporary teeth. Later, the walls of the process are 
built up, so as to surround the root of each tooth with a bony 
wall. This same wall is resorbed with the roots of the tem- 
porary teeth when they are shed. For the permanent teeth 
the process is rebuilt as before. 

What tissues of the teeth are developed from the con= 
nective tissue group? 

Dentine, cementum, pulp and its vessels. 



HISTOLOGY. 327 

What are the Striae of Retzius? 

The stripes of Retzius are dark lines in the enamel passing 
in a direction generally parallel to the surface of the enamel. 
These are due, no doubt, to inequalities in development, and 
also in density of its substances. 

Describe the stratum Malpighii. 

This is the deepest layer of cells of the oral epithelium 
which comprises the active portion of the enamel organ. It 
consists of columnar and polyhedral shaped cells. 

Describe the blood supply to the tooth pulp and peri- 
cementum. 

The arterial twigs enter the pulp canal by the apical fora- 
men and break up into a plexus of capillaries arranged 
densely at the periphery beneath the layer of odontoblasts. 
From the same artery branches extend upwards into the 
pericementum ; branches are again distributed laterally in the 
pericementum, some of which pass for a short distance into 
the cementum and the adjacent alveolar wall. 

What is cartilage? 

Cartilage is a dense variety of connective tissue. It is 
more or less translucent, containing in the matrix a principle 
known as chondrin, which gives density, and to a degree 
elasticity, to the cartilage. Cartilage occurs at the articular 
surfaces of all long bones; between the articulations of some 
bones; the costal cartilage; external ear; and in the embryo, 
— the entire skeleton, except the bones of the face and 
cranium, and part of the inferior maxilla. 

Name the three organs which effect the calcification of 
the tooth. 

The ameloblasts of the enamel organ, the odontoblasts of 
the dentinal papilla, and the cementoblasts of the alveolar 
periosteum. 



328 HISTOLOGY. 

Describe a transverse section of the root of a tooth, as 
seen under the microscope. 

In the interior of the root, will be seen an opening; this 
corresponds to the lumen of the pulp canal. Whether or not 
the pulp will be seen will depend upon the method of pre- 
paration of the specimen. Dried specimens are best for 
examining the structure of the bulk of a tooth, in which pre- 
paration the pulp will not be demonstrable. On the periphery 
will be seen a zone of osseous tissue, the cementum; the ex- 
terior of this may or may not show the remains of the 
peridental membrane. Internal to the cementum lies the 
dentine, the tubules of which arranged radially extend from 
the pulp canal as a center. 

With what do the dentinal tubules connect at their 
inner extremities? 

The pulp chamber. 

What tissues of the oral cavity are formed from the 
epiblastic layer? From the mesoblastic layer? 

From the epiblast are developed the epithelium of the 
mouth, including its glands, the enamel organ, and nerves. 

From the mesoblast are developed the tunica propria of the 
mucous membrane, its blood vessels and lymphatics, muscle 
fibers, dental papillae and their products. 

Where are the lines of Schreger found? (b) Salter? 

(a) Schreger 's lines occur throughout the dentine. 

(b) Salter's incremental lines are found in the outer layer 
of dentine. 

Name the different kinds of cells found in the alveolo- 
dental membrane. 

This membrane contains, as does other connective tissue, 
spindle-shaped connective tissue cells. In addition, it con- 
tains special cells. The cementoblasts for the production of 
cementum; the cementoclasts, for resorption. 

With what do the dentinal fibrils connect? 

The odontoblasts. 



HISTOLOGY. 329 

What is the purpose of secondary dentine? How does 
it differ from true dentine? 

Secondary dentine, when formed in carious teeth, serves to 
supply the loss sustained by the weakening of the wall. 
Secondary dentine is frequently found in the teeth of old 
persons without caries. This is due to stimulation of th<3 
odontoblasts by some irritant. 

Secondary dentine differs from true dentine, in the fact 
that it is usually irregularly and imperfectly calcified. It is 
also known as osteo- dentine. 

What form of epithelium lines the oral cavity? From 
what elementary tissue is it developed? 

Stratified squamous ; developed from the epiblast. 

State the various cell layers of the completed enamel 
organ. Give their relative position. 

The layer of ameloblasts which forms the deepest layer 
lies adjacent to the dental papilla; the stellate reticulum, or 
layer of polyhedral cells, which occupy the interior of the 
enamel organ; the superficial epithelial layer, which is a 
direct continuation of the oral epithelium ; between the super- 
ficial stratum and the stellate reticulum lies the "stratum 
intermedium. ' ' 

Where does calcification first appear in a developing 
tooth, and what size and shape is the dentinal germ? 

"Calcification of dentin begins on the coronal extremities 
of the crowns. The dentinal germ is the same size and shape 
as the crown of the future tooth. ' ' 

Describe the different tissues of the teeth and give their 
location? 

Enamel, dentine, cementum and pulp. The enamel covers 
the crown of the tooth, dentine forms the body of the tooth 
and is intermediate in position between the enamel and 
pulp ; the pulp occupies the central chamber of the tooth and 
the cementum covers the roots of the teeth. 



330 HISTOLOGY. 

How do the arterial vessels in the pulp differ from those 
just outside of the apical foramen? 

The arterial vessels in the pulp are found as a capillary- 
network, composed of a layer of endothelial cells while those 
outside of the foramen are much larger consisting of two 
coats. 

With what is the surface of the gum covered? 

Mucous membrane. 

What is the function of the peridental membrane and 
how does it receive its blood supply? 

The function of the peridental membrane is to hold the 
tooth in its socket, give sense of touch to the tooth, act as a 
cushion to receive shock due to mastication, to nourish the 
tooth when the pulp is devitalized and to nourish the cemen- 
tum of the tooth. It receives its blood supply from the 
same arterial branch as the tooth, this branch giving off 
several twigs before entering the apical foramen. 

What is the structural difference between an artery 
and a vein? 

Veins have, on the whole, much thinner walls than arteries 
in proportion to the calibre of the vessels. The endothelial 
cells of veins are broader and shorter than in arteries. Veins 
contain less muscle but more connective tissue than arteries. 

Describe fully the white corpuscles of the blood and 
give their origin. 

The white corpuscles at rest are globular nucleated masses 
of protoplasm about g-sVir °f an i ncn i n diameter. There 
are a number of varieties. The small mononuclear or lym- 
phocyte, the large mononuclear or transitional, the poly- 
morphonuclear, which is the most abundant, and the eosin- 
ophile containing coarse granules readily stained with eosin. 

The leucocytes have the power to throw out pseudopodia, 
or, as it is called, amoeboid movement. They originate in the 
lymphatic tissue and in the marrow of bones. 



HISTOLOGY. 331 

How is secondary dentine formed? 

By the odontoblasts being stimulated into activity by irri- 
tation of the pulp. It is most frequently caused by the 
advance of caries. 

How is cellular activity stimulated in the resorption of y 
the roots of deciduous teeth? 

By the vascular papilla and probably by the pressure 
caused by the advance of the permanent teeth. 

How and from what source does a tooth receive its 
blood supply? 

By means of the pulp and pericemental membrane; from 
the inferior dental to the inferior teeth, and from the alveo- 
lar and infra-orbital to the upper teeth. 

Describe the natural means by which the deciduous 
teeth are shed. 

The resorption begins at the apical extremities of the root 
and gradually progresses towards the crown. It is brought 
about by the agency of the osteoclasts; resorption taking 
place in the order of eruption contained in vascular papillae. 

Describe the dental tubuli. 

The dental tubuli are small wave-like canals which run 
from the periphery of the pulp in a perpendicular direction 
to the surface. They vary in size from 1.1 to 2.3 microns. 
They anastomose freely. 

Describe an odontoblast. 

They are large elongated, multipolar, nucleated cells. 
Before dentinification they are spheroid. During this pro- 
cess their extremities become somewhat flattened and square. 

What tissue is developed from the outer layer of cells, 
and what of the inner layer of the follicular sac? 

From the outer, the peridental membrane is developed and 
from the inner layer the cementum is developed. 



332 HISTOLOGY. 

From what sources do the different structures of a 
tooth receive their nourishment? 

The enamel, from the dentine; dentine, through the pulp; 
pulp, from its vascular supply; cementum, from the peri- 
dental membrane. 

What is spongioplasm? 

Spongioplasm is a part of the protoplasm of a cell. It is a 
very delicate network which supports the fluid portion of 
the protoplasm. 

What is the nucleus of a cell? 

The nucleus is usually a round or oval body situated in 
the interior of the cell body. It consists, like the protoplasm, 
of two parts; (1), the chromatin, having, as the name im- 
plies, a great affinity for stains; it is arranged in the form 
of a delicate reticulum. (2), The achromatin, a clear semi- 
fluid substance, staining feebly, if at all, and occupying the 
meshes of the chromatin. Within the nucleus may be seen 
one or more smaller rounded bodies, — the nucleoli. The 
nucleus is in many instances limited by a distinct nuclear 
membrane. 

What is nuclear matrix? 

The nuclear matrix is the inter-fibrillar substance of the 
nucleus. A clear semi-fluid, homogeneous substance. 

Is dentine developed inwardly or outwardly? 

Dentine develops from without toward the papilla. 
In what manner does dentine increase? 

By a gradual deposit by the odontoblasts, of layers of a 
substance which later becomes calcified. 

What would be the result of exposing dentine to the 
action of a strong acid for several days? 

The earthy substance would be removed and a substance 
yielding gelatin would remain. 

What is the structure of human enamel? 

Enamel is an exceedingly hard substance. It is composed 



HISTOLOGY. 333 

of elements prismatic in shape, usually six-sided, placed verti- 
cally to the dentine, and are united by a cement substance. 
It exhibits parallel stripes representing strata of lime salts 
deposited, called the stripes of Retzius. 

Give the varieties of connective tissue. 

White fibrous. 

Yellow elastic. 

Areolar and modifications: adipose and adenoid. 

Mucous or embryonic. 

Cartilage. 

Bone. 

Dentine. 

Give the analysis of cementum. 

Cementum has a composition like that of bone. Of or- 
ganic matter, there is about 33%. The remainder consists 
of inorganic substance in the form of the phosphates of lime 
and magnesium, carbonate of lime, sodium chloride and 
calcium fluoride. 

What is an organic tissue? 

An organic tissue is one in which the structural elements 
are chiefly, if not entirely, composed of living organized 
substances. 

Define lymphatics. Are lymphatics found in the teeth? 

Lymphatics are vessels, with exceedingly delicate walls, 
the function of which is to take up the excess of nutrient 
fluids that have been poured from the capillaries for the nour- 
ishment of the tissues, and return it to the blood stream. 
They also carry the nutrient fluids from the digestive canal. 
No distinct lymphatics have been demonstrated in the teeth. 

What is hemoglobin? 

The coloring matter of the red blood cell, which, when 
separated from the blood, crystallizes into the form of elon- 
gated prisms. It is a proteid substance having a great 
affinity for oxygen. 



334 HISTOLOGY. 

State the kinds of nerve fibers. 

Medullated, or white fibers; non-medullated, gray, or 
Remak's fibers. 

Describe the secondary dentine. 

Late in life the pulp cavity becomes more or less filled with 
a dense substance, the structure of which is intermediate be- 
tween dentine and bone. It is a secondary dentine, also 
called osteo-dentine. 

Describe a ganglion. 

Ganglia are bulbous structures situated on the posterior 
nerve roots of the spinal cord, on some of the cranial nerves 
and in the sympathetic system. They consist of a collection 
of nerve cells, each being enclosed in a capsule which is con- 
tinuous with the sheath of the fiber communicating with it. 
The cells are enclosed in a reticulum of connective tissue which 
also contains additional nerve fibers not connected with the 
cell. 

From what germ layers is epithelium developed? 

Epithelium is developed from the ectoderm, entoderm and 
mesoderm. 

What is histology? 

The term histology is derived from the Greek "histos" a 
web, or tissue; and " logos" a treatise. It is that part of 
science which has for its object the study of tissues. 

What is protoplasm? 

Protoplasm is a proteid substance, containing, in addition, 
some inorganic substances, viz. : phosphorus, calcium. Struc- 
turally it consists of a reticulum, the spongioplasm, in the 
meshes of which is contained a clear semi-fluid substance, the 
hyaloplasm. 

What is a cell? 

A cell is a structural element. It consists of a nucleated 
mass of protoplasm endowed with the properties of life, — 
growth, metabolism, reproduction, motion and irritability. 



HISTOLOGY. 335 

What is the peridental membrane? 

It is that part of the alveolar periosteum which is re- 
duplicated upon the root of the tooth for the purpose of bind- 
ing the tooth in the socket, producing the cementum, and of 
supporting blood vessels. 

Give analysis of dentine and enamel. 

Dentine contains about 28% of animal matter and 72% 
of earthy matter. Enamel contains but about 4% of animal 
matter. The earthy matter in both consists of the phosphates 
of calcium and magnesium, carbonate and fluoride of calcium. 

What is a tooth germ? 

The structure consisting of embryonal tissues from which 
the tooth is developed. 

How is bone developed? 

(1) In cartilage, where the substitution of calcined sub- 
stance is effected by the osteoblasts. (2) In fibrous tissue, 
by the deposit of calcified substance upon the bundles of 
fibrous tissue. (3) From the periosteum, by an ingrowth 
of periosteal buds. This variety also substitutes cartilage, 
but differs from the enchondronal in that it grows from the 
surface. 

What is epithelium? 

Epithelium is an elementary tissue found covering surfaces 
and lining cavities. The cellular element exceeds the inter- 
cellular in amount, the latter consisting of but a small quan- 
tity of inter-cellular cement substance. 

Of what is each of the following composed: (a) the 
hair, (b) the nails, (c) the enamel of the teeth? 

The hair is a modification of the epithelium of the epi- 
dermis; the nails are a very highly developed part of the 
stratum lucidum of the epidermis. The enamel of the teeth 
is a product of the epithelium of the oral cavity. 

Describe the Haversian system. 

An Haversian system occurs in compact bone and consists 



336 HISTOLOGY. 

of a system of channels through which the nutrient fluids 
pass. It consists of the following: a centrally placed canal, 
the Haversian canal, which is surrounded by concentric lay- 
ers or plates of bone, the lamellae. Between the plates of 
bone are irregular clefts, the lacunae, which communicate 
with each other and with the Haversian canal by means of 
radially placed canals, — the canaliculi. 

What is periosteum? Of what tissues is it formed? 

A membrane which, as its name indicates, invests the bone 
for the purpose of supporting the blood-vessels, and also 
to take part in the growth of bone. It consists of two layers; 
(1) an outer, composed of white fibrous tissue, containing 
numerous blood-vessels. (2) The inner, or osteogenetic layer, 
which is rich in elastic fibers and spindle-shaped cells, — 
osteogenetic cells. 

Describe the formation of the teeth. 

The teeth are composed of three substances, — the enamel, 
the dentine and the cementum. The enamel covers the ex- 
posed part of the tooth, the crown of the tooth. The cemen- 
tum covers the part of the tooth within the alveolus of the 
jaw. The junction of the enamel with the cementum is called 
the neck of the tooth. The bulk of the tooth is made up of 
the dentine, which extends from the root to the crown. 
Each tooth contains a cavity, the pulp cavity, which com- 
municates with the exterior through a small aperture at the 
apex of the root, the apical foramen. The cavity contains 
a soft connective tissue, — the pulp, rich in vessels and nerves. 
The fang, or root of the tooth has a fibrous investment called 
the peridental membrane, or periosteum. 

What is an odontoblast? 

An odontoblast is a modified and specialized connective 
tissue cell, for the production of dentine. 

Where are nerve cells found? Describe their structure 
and functions. 

Nerve cells exist in the gray matter of the cerebrum, cere- 



HISTOLOGY. 337 

bellum, spinal cord and the posterior nerve root ganglia, in 
the sympathetic nervous system, and in the medullary por- 
tion of the supra-renal capsules, according to some authori- 
ties. A nerve cell consists of a cell body, — a large nucleated 
mass of protoplasm having prolongations or poles, and usually 
containing a nucleolus. Nerve cells are classified according 
to the number of processes, as unipolar, bipolar and multi- 
polar. Each nerve cell is the point at which a nerve fiber 
originates in one of the protoplasmic processes, known as the 
axis cylinder process. The other processes when present 
are branched, therefore, are called dendrites. The function 
of nerve cells is to generate nervous impulses. 

Describe the structure of a salivary gland. 

A salivary gland is a tubulo-racemose gland. It is in- 
vested with a fibrous tissue capsule which sends trabeculae into 
the substance of the gland to divide it into lobes; these in 
turn are subdivided into lobules. Each lobule consists of a 
collection of secreting units, the acini, which are composed 
of glandular epithelium resting upon a basement membrane. 
The secretion leaves the gland through its ducts, named ac- 
cording to their position in the gland. The interlobular 
ducts between the lobules, the intralobular ducts within the 
lobules, and the intermediate ducts leading from the acini 
to the intralobular ducts. Acini may be of the serous type, 
the cells of which are granular and stain deeply; or mucous, 
the cells being clear and staining faintly. 

What tooth germ first appears and at what period? 

Of the temporary teeth, the germ for the first molar ap- 
pears in the sixth week of embryonic life. 

Is dentine vascular? Explain. 

Dentine does not contain blood vessels. It probably re- 
ceives its nourishment indirectly from the vessels of the pulp 
as does the true bone by means of its canaliculi. 

What is connective tissue? 

A tissue of mesodermic origin which is composed of a 
22 



338 HISTOLOGY. 

cell alar and intercellular substance, the latter being pre- 
dominant. The cells vary in shape, being round, spindle- 
shaped, stellate and fusiform. The intercellular sub- 
stance consists of fibres and a matrix which vary in 
their characteristics in various kinds of connective tissue. 

Where does cementum form the thickest? 

At the apex of the fang of the tooth. 

Mention the structures contained in a cell. 

A typical cell contains a cell wall or membrane, cell contents 
or protoplasm, nuclear membrane, nucleus, nucleolus. Some 
cells contain merely the protoplasm and the nucleus. 

What are the primary germ layers? 

The ectoderm or epiblast, mesoderm or mesoblast, ento- 
derm or hypoblast. 

Describe (a) mucous tissue, (b) white fibrous tissue, 
(c) elastic tissue. 

(a) Mucous tissue is a transparent, jelly-like tissue. Micro- 
scopically it is composed of stellate cells arranged in a homo- 
geneous semi-fluid matrix. 

(b) White fibrous tissue consists of delicate white fibers. 
It may be dense, as in tendons, or loose, as in areolar tissue. 
The fibers do not branch. On boiling fibrous tissue it yields 
gelatin. 

(c) Elastic tissue consists of yellow highly refractile fibers 
which branch freely and have a great tendency to curl at the 
free ends. The fibers are very elastic and when boiled 
yield elastin. 

Describe two kinds of bone development. 

In enchondronal bone, hyaline cartilage becomes trans- 
formed into osseous tissue. First the cartilage cells multiply 
and become arranged in vertical rows, particularly at the 
epiphyses, and the substance between the cells becomes the 
seat of a deposit of lime salts. In order that the marrow 
cavity and the Haversian canals or spaces be formed, certain 



HISTOLOGY. 339 

cells called osteoclasts absorb some of the osseous tissue. In 
long bones ossification also takes place from the periosteum 
by periosteal buds growing into the cartilage. 

Intra-membranous bone develops in fibrous tissue. The 
bundles of fibres become calcined by the deposit of lime salts 
upon them by the osteoblasts. This usually takes place in a 
manner radiating from a centre of ossification. 

Describe osteoblast, osteoclast. 

An osteoblast is a bone-making connective tissue cell. An 
osteoclast is a cell which absorbs the calcined substance of 
bony structures. 

State the difference between compact bone and spongy 
bone. 

Compact bone is densely made up, being composed of layers 
of calcified matrix, called lamellae. It contains Haversian 
canals, with concentric lamellae, between the Haversian sys- 
tems, — interstitial lamellae ; lamellae concentric with the peri- 
phery of the bone ; and, if a long bone, perimedullary lamellae. 
Spongy bone is loosely constructed, being composed of an in- 
terlacement of calcined septa forming spaces called Haversian 
spaces. 

What tissue binds together the voluntary muscle fibers? 

Extensions from the connective tissue covering of the 
muscles, called the endomysium. 

What is the sarcolemma? 

The delicate sheath investing the muscle fiber of striated 
voluntary muscle. 

Define neuro=epithelium and state where it is found? 

Neuro-epithelium is of ectodermic origin, and consists of 
modified epithelial cells situated at the terminal of nerves 
of special sense for the purpose of receiving impulses. 

Describe the axis cylinder, the medullary substance, the 
neurilemma. 

These are parts of a so-called medullated nerve fibre. The 



340 HISTOLOGY. 

axis cylinder is the essential part; it begins at the origin of 
the nerve fiber in the cell and continues to the termination 
of the fiber. It occupies a central position in the fiber and 
appears to be made up of delicate fibrillar the primitive 
fibrillar It is said to have a delicate sheath, the axilemma. 
The medullary substance is the substance which invests the 
axis cylinder of medullated fibers. It is known as the "white 
substance of Schwann. ' ' It is of a fatty nature and is regarded 
as serving to insulate the axis cylinder. It is not continuous, 
being interrupted at points called the ' ' nodes of Ranvier . The 
neurilemma is the primitive sheath forming the covering of 
the nerve fiber. It is a structureless, transparent membrane 
beneath which are situated nuclei, surrounded by a small 
amount of protoplasm forming the nerve corpuscles. 

From what layer of the embryo is the vascular system 
developed? 

From the mesoderm. 

Where does calcification of a tooth begin? 

Calcification of the enamel begins at that part nearest the 
papilla. In the dentine, it begins at the periphery of the 
papilla. 

What tissues are derived from the mesoblast? 

All forms of connective tissue, muscular tissue, endothe- 
lium of the blood and lymph vessels, pericardium, endocar- 
dium, pleura, peritoneum, spleen, kidney and ureter, testicle 
and ducts, ovary and Fallopian tubes, uterus and vagina. 

Describe the cellular elements and the fluid portion of 
the blood. 

The cellular elements of the blood are the erythrocytes, or 
red blood cells, and the leucocytes, or white blood cells. The 
fluid portion is the plasma, or liquor sanguinis, in which the 
cells are suspended. The red blood cells are of a greenish- 
yellow cast, but when massed together give the red appear- 
ance to the blood. In distinction to the white blood cells, they 
are not nucleated as the latter are. They occur in the pro- 



HISTOLOGY. 341 

portion of 500 red to 1 white. White blood corpuscles have 
the power of amoeboid motion. There are several varieties 
of leucocytes named according to the character of the nucleus 
and affinity for stains. The most important are the poly- 
nuclear leucocytes occurring in about 70% of all the leuco- 
cytes. The fluid part of the blood is a somewhat sticky, 
clammy liquid. It contains the factors of fibrin, namely, 
fibrinogen and fibrin fermenrt, which are the agencies active 
in the clotting of blood. 

Describe the dental ridge. 

It consists of a linear thickening of the primitive oral 
epithelium from which the enamel germ is later formed. 

What layers of the embryo contribute to the develop= 
ment of the teeth? 

The ectoderm and the mesoderm. 

Which of the permanent teeth first calcify? 

The first molars (sixth month) in the upper jaw. A little 
later in the lower jaw. 

What is the origin of the cementum? 

Cementum has its derivation in the alveolar periosteum. 
What is a phagocyte? 

It is a cell possessing the power of amoeboid movement, by 
means of which it takes in and incorporates particles with 
its own substance. It is usually a leucocyte. 

What are leucocytes? 

The colorless corpuscles of the blood, usually known as 
white corpuscles. 

How many kinds of bone tissue are there? 

Bone is usually divided into two varieties; (1) compact, 
or dense, and (2) cancellated, or spongy. 

What is tissue? 

Tissue is an arrangement of structural elements and con- 



342 HISTOLOGY. 

eists of a cellular and an inter-cellular substance. When the 
structural elements are of the same type, it is known as a 
simple or elementary tissue; when of more than one type, it 
is a complex tissue. 

What is the blastoderm? 

The blastoderm is a sac-like arrangement, of embryonal cells 
formed by the cleavage of the ovum. It consists of three 
layers: ectoderm, mesoderm and entoderm; from these all 
of the tissues of the animal body are developed. 

How do cells receive their nourishment? 

Cells are nourished by means of the nutrient blood plasma 
which escapes from the walls of the ultimate capillaries in the 
tissue. The cells are literally bathed in the blood plasma. 

What is embryology? 

That part of science which treats of the development of 
the embryo is known as embryology. 

Describe the development of blood vessels and lym=> 
phatics. 

Having a mesodermic origin, the blood and lymph vessels 
first appear as "cords" of cells which later become hollow to 
form tubes. The innermost cells become distinctly flattened 
to form the endothelial lining. The first blood vessels have 
their beginning outside the body of the embryo, in the yolk-sac. 

Describe the muscular tissue. 

Muscular tissue is of mesodermic origin and consists prin- 
cipally of elongated cells (fibrous cells) which have the in- 
herent power of contracting. The muscle fibers contain 
nuclei and, sometimes, that which corresponds to a cell wall, 
the sarcolemma. Voluntary and cardiac muscles are striated, 
due to the arrangement of alternate light and dark discs. 
Non-striated muscle is involuntary. Microscopically, they 
may be differentiated as follows: 



HISTOLOGY. 343 

Striated. Non-Striated. Cardiac. 

Fibers striated trans- No striations. Striated longitudinally and 

versely. transversely. 

Has sarcolemma. Hyaline sheath. No sarcolemma. 

Nucleus beneath sar- Nucleus in cen- Nucleus oval and in center. 

oolemma. ter. 

Fibers do not branch, Fibers short. 

except in the tongue. Fibers branch freely. 

To what class of tissues do the teeth belong? 

With the exception of the enamel, which is a product of epi- 
thelium, the teeth belong to the connective tissue group. 

From what is the six=year molar derived? 

The enamel germ of the first permanent molar appears at 
the extremity of the dental ridge after the manner of a 
temporary tooth ; it appears about a week before the budding 
of the germs of the temporary teeth. 

Give the principal tissues of the animal body. 

Blood and lymph, epithelium, connective, muscular and 
nervous. The blood and lymph are often classified with the 
connective tissue. 

State the functions of epithelium. 

Protective, secretory, absorptive, to permit exchange of 
gases, to produce motion (ciliary), for the reduction of fric- 
tion (endothelium) , and for the reception of nervous impulses. 

What are the soft fibers of Tomes? 

Prolongations of the odontoblasts into the dentinal tubules 
are known as "fibers of Tomes." 

State the size, shape and structure of a human red 
blood corpuscle. 

The red blood corpuscles are disc-shaped, biconcave, and 
are 1-3200 of an inch in diameter. They are not nucleated; 
and, though they probably have a delicate cell wall, none can 
be demonstrated. The cell contains a substance, hemoglobin, 
which gives the color to the cell. 



344 HISTOLOGY. 

Describe the structure of arteries. 

The medium-sized arteries are composed of three coats or 
tunics. The tunica intima (inner), consisting of an endo- 
thelial lining, resting upon a sub-endothelial layer of loose 
connective tissue, which is separated from the middle coat by 
a layer of elastic tissue, lamina elastica interna. The tunica 
media (middle) is a muscular tunic and consists of a layer 
of involuntary (non-striated) muscle fibers circularly ar- 
ranged. The tunica adventitia (outer) consists of an ad- 
mixture of white fibrous and yellow elastic connective tissues. 
This tunic contains small vessels which nourish the artery, 
called vasa vasorum. 

To what tissue does dentine belong? 

To the connective tissue of the dense variety. 
What is bioplasm? 

The living substance of the cell. The term is often used 
synonymously with protoplasm. 

Mention the varieties of epithelium. 

Squamous, columnar, ciliated, glandular, transitional, pig- 
mented, and neuro-epithelium. The first three may occur 
in a single layer, when it is named "simple;" or, in several 
layers, when it is called "stratified." 

Describe the more minute structures which evolve the 
sense of taste. 

On the dorsum and sides of the tongue, particularly the 
former, are elevations of the mucous membrane in the form 
of papillae. 

A few of the papillae (8-12). situated on the posterior 
part of the dorsum of the tongTie. are surrounded by a fur- 
row, hence called the circumvallate papillae. They are ar- 
ranged in the form of the letter "V," the apex being directed 
posteriorly. These papillae usually bear secondary papillae. 
Embedded in the stratified squamous epithelium on the sur- 
face of the papillae are oval bodies composed of modified 
epithelial cells arranged "like the staves of a barrel." These 



HISTOLOGY. 345 

are the taste buds which are communicant with the terminals 
of the gustatory nerve. 

The fungiform papillae, more numerous than the cir- 
cumvallate, receive filaments of the nerves of taste ; but there 
are fewer of the "special endings" than in the circumvallate. 
Secondary papillae do also occur on the fungiform papillae. 

The largest number of the papillae is of the conical or fili- 
form variety, consisting of a conical elevation of connective 
tissue covered with epithelium. They carry the terminals of 
the nerve fibres to the periphery. 

Describe the cell structure of articular cartilage. 

The articular surfaces are covered with hyaline cartilage, 
the distinguishing feature of which is the translucency of its 
matrix. The matrix, which presents a homogeneous appear- 
ance, contains many cartilage cells which occupy and com- 
pletely fill spaces called lacunae. Sometimes, two or more 
cells occur in a single lacuna. The cells are distinctly nu- 
cleated; the youngest are spindle-shaped and occupy a posi- 
tion next to the perichondrium, while the oldest cells are 
deeper and~are irregularly rounded, having a tendency to 
become angulated. 

How does a mucous membrane differ from a serous 
membrane? 

Mucous membranes line all cavities communicating directly 
or indirectly with the atmosphere. They consist of an epi- 
thelial covering, the variety of which varies with the loca- 
tion, resting upon a connective tissue base, — the tunica 
propria. Extensions of the epithelium into the connective 
tissue beneath, arranged in the form of tubes or sacs (usu- 
ally the latter) which secrete mucous for the purpose of 
moistening the surface of the membrane, form the mucous 
glands. 

Serous membranes are found lining closed sacs. They con- 
sist of a single layer of endothelial cells resting upon a con- 
nective tissue membrane. Minute openings, stomata. existing 
between some of the cells, communicate with lymph capillaries. 



346 HISTOLOGY. 

The fluid found on the surface of serous membranes comes 
from the lymph channels. Serous sacs may be regarded as 
large lymph spaces. 

Describe the pericemental membrane. Give its origin 
and function. 

The pericemental membrane is the fibrous tissue investment 
which covers the root of the tooth. The fibres composing it 
run, for the most part, transversely. Elastic fibres are not- 
ably absent. It has its origin in the outer layer of the dental 
sac. This membrane serves to hold the tooth in the alveolus, 
and, to furnish the nutrition to the cementum through the 
blood vessels it carries. Acting as a cushion, it seems to di- 
minish shock during mastication. 

Differentiate between osteoclasts and cementoblasts. 

Osteoclasts are connective tissue cells found in bone-form- 
ing tissue. It is by their agency, the absorption of calcified 
matrix, that the Haversian canals and spaces are formed. 

Cementoblasts are also connective tissue cells, but their 
function is that of depositing lime salts in the matrix of the 
cementum. 

Describe the process of dental calcification. 

At about the end of the fourth month, the enamel of the 
temporary teeth is formed. From the extremity of the 
enamel cells, next to the papillae, develops a tuft-like pro- 
jection, which becomes calcified, forming an enamel prism. 
The process of calcification proceeds therefore from within 
outward. 

At about the same period, the deposit of dentine on the 
sides and apex of the dental papillae begins, and therefore 
proceeds from without inward. Calcification of the dentine 
is not complete, for the areas known as interglobular spaces 
are not calcified, nor are the processes of the odontoblasts, 
— 'the dentinal fibres. 

Describe the structure, blood supply and nerves of the 
pulp. 

The pulp consists of embryonic connective tissue which is 



HISTOLOGY. 347 

composed of stellate cells arranged in a semifluid, transparent 
matrix. 

Next to the wall of the pulp canal are columnar shaped 
cells, the odontoblasts, processes of which enter the dentine 
as the dentinal fibrils. 

The pulp is well supplied with blood-vessels and nerves 
which enter at the apical foramen. After entering the pulp 
canal they break up to form plexuses which terminate in 
the layer of odontoblasts. 

The function of the pulp is that of furnishing nutrition 
to the dentine and enamel. Due to the rich nerve supply, the 
pulp is very sensitive. 

From what is the mesoblast derived? 

The mesoblast has its origin partly in the epiblast and 
partly in the hypoblast, though chiefly the latter. 

What two tissues are formed by the dental papilla? 

The dentine which is deposited at the periphery of the 
papilla; and the pulp, which is that portion of the papilla 
remaining after dentine has been formed. 

Describe separately the calcified products of the con- 
nective tissue. 

Bone may be considered to be of two kinds: compact, or 
dense, and cancellated, or spongy. 

Compact bone consists of a dense matrix containing lime 
salts, which matrix contains numerous channels for the pas- 
sage of nutrient vessels and fluids, also clefts or spaces, con- 
taining bone cells. The largest channels (1-500 inch in 
diameter), called "Haversian Canals," run parallel with the 
long axis of the bone and form anastomoses with one another. 
The canals are surrounded with concentric layers of osseous 
matrix: Haversian lamellae, between which are small spaces, 
the lacunae, which in recent bone contain bone cells. Radiat- 
ing from the Haversian canals to the lacunae, are minute 
channels which convey lymph. They are the canaliculi. 
The above named structures form what is termed an 



348 HISTOLOGY. 

"Haversian System." Between the systems, which are circu- 
lar, interstitial lamellae occur, thus filling the space that 
otherwise would exist. 

Lamellae also occur concentrically with the periphery of 
the shaft of the bone, the circumferential lamellae, and with 
the medullary canal, the perimedullary lamellae. 

Spongy bone does not contain Haversian systems, and, 
therefore, no Haversian canals. There are, however, as the 
name implies, numerous spaces in the matrix ; they are known 
as "Haversian spaces." 

Dentine consists of a calcified matrix in which, extending 
through the entire thickness of the matrix, are seen the den- 
tinal tubules which terminate in irregular clefts at the junc- 
tion of the dentine with, the enamel and cementum. These 
clefts are known as the interglobular spaces. The part of 
the matrix immediately surrounding the tubules forms the 
dentinal sheaths. The tubules contain processes of cells at 
the periphery of the dentine, — the dentinal -fibres. 

Cementum resembles very closely the structure of bone. 
Near the apex of the root, where the cementum is thickest, 
Haversian canals may sometimes exist, though usually they 
are not present. 

What tissue is the origin of the enamel? What are 
ameloblasts? 

Enamel originates in the oral epithelium. 

Ameloblasts are the enamel-producing cells. They are dis- 
tinctly columnar in shape and occupy a position in the 
enamel organ nearest the dentine. 

Describe the development of the dental papilla? 

The dental papilla is of connective tissue origin. Its posi- 
tion is first evidenced by a proliferation and condensation 
of the mesodermic elements. This collection of cells soon 
assumes the shape of a cone, its apex pointing towards, and 
later invaginated by the enamel organ. The apex and sides 
of the conical mass become surrounded by columnar cells, — 
the odontoblasts, which are the producing agents of the 
dentine. 



HISTOLOGY. 349 

By what cells, and under what conditions does resorp= 
tion occur? 

Cells which are endowed with the funtion of breaking 
down osseous tissue, namely the osteoclasts, are active in the 
process of resorption. Resorption takes place previous to the 
eruption of the permanent teeth and is stimulated by the 
increased blood supply and pressure of the unerupted per- 
manent teeth. 

Describe Meckel's cartilage. 

Meckel's cartilage is a rod of cartilage which appears in 
the mandibular arch and partly enters into the formation of 
the inferior maxilla, namely, the extremity at the symphysis 
and the proximal extremity, which persists with a covering 
of fibrous tissue to form the internal lateral ligament of 
the jaw. The greater part of Meckel's cartilage disappears 
at about the sixth month of foetal life. 

Name the specialized cell for each particular structure 
of the teeth. 

The specialized cell of the enamel is the ameloblast. That 
for the dentine is the odontoblast. For the cementum, the 
cementoblast. 

What are interglobular spaces? 

At the junction of the dentine with the enamel and cemen- 
tum are areas which are imperfectly calcified; they are some- 
what globular in shape, hence, called interglobular spaces. 

Describe the dental follicle. 

The dental follicle is the result of the condensation of the 
mesodermic cells surrounding the papilla, which later extends 
upward so as to surround the entire rudimentary tooth. 

Why should there be a difference between the struc- 
ture of dentine and cementum? 

Dentine is a product of embryonic connective tissue through 
the specialized cell, the odontoblast; while the cementum is 
produced by the connective tissue cells of the alveolar perios- 



350 HISTOLOGY. 

teum, the cementoblasts ; therefore, the structure of the ee- 
mentum resembles that of bone. 

Describe the enamel organ and the cells that form 
enamel. 

The enamel organ has its origin in a down-growth of the 
oral ectodermic tissue. When fully developed it consists of 
a sac, the lower margin of which is indented by reason of its 
contact Avith the underlying papilla; structurally, it consists 
of three layers of cells. An upper, continuous with the super- 
ficial cells of the ectoderm, a middle layer of stellate cells, and 
an inferior layer of distinctly columnar shaped cells. The 
last named cells are the cells which produce enamel. The 
enamel cells, when active in the production of enamel, exhibit, 
at their lower extremity (toward the papilla), a tuft of short 
processes. It is along these processes that the deposit of the 
enamel takes place. 

What is the primitive dental groove? (b) What organ 
of the teeth is developed from it? 

A longitudinal furrow, seen on the surface of the ecto- 
dermic tissue, which marks the point of attachment of the 
dental ridge, lying immediately beneath, (b) The enamel 
organ. 

Describe the dental fibrillae; with what are they con- 
nected, and where do they terminate? 

The dental fibrillae occupy the dental tubules and extend 
throughout their length. The fibrils are protoplasmic ex- 
tensions of the odontoblasts terminating at the periphery of 
the dentine. 

Describe the stratum granulosum. 

At the periphery of the dentine, the substance is not com- 
pletely calcified. As a result there are small irregular clefts, 
the interglobular spaces. This layer of the dentine is known 
as the granular layer. 



HISTOLOGY. 351 

What is Neuman's Sheath? 

The part of the dentinal matrix immediately surrounding 
the dentinal tubules constitutes the so-called dentinal sheaths, 
or sheaths of Neuman. 

What is calcification? 

Calcification is the process by means of which tissue may 
become infiltrated with lime salts. It is a product of the cellu- 
lar element of the tissue that is deposited in the intercullular 
substance of which it becomes a part. Calcification usually 
is effected in layers, and, in the instance of bone and oemen- 
tum, the well defined lamellae are formed. 

Mention the methods of distribution of cells in the 
various tissues. 

On surfaces, (epithelium and endothelium). 
Suspended in fluid, (blood and lymph). 
Interstitially, in a matrix (connective tissues). 

What is perichondrium? 

A fibrous investment covering cartilage. It consists of an 
outer fibrous, the vascular layer; an inner chondrogenetic 
layer, composed of spindle-shaped, cartilage-forming cells. 

Name the varieties of cartilage. 

White fibro-cartilage, yellow elastic cartilage, hyaline 
cartilage. 

Which variety of cartilage does not have a perichon= 
drium? 

White fibro-cartilage. 

How may all tissues be classified? 

According to (1) their ancestry, (2) function, (3) morpho- 
logical character. 

Explain the difference between epithelium and endo- 
thelium. 

Epithelium and endothelium occur on surfaces, but the 
location, the function and the arrangement varies. 



352 



HISTOLOGY. 



Ancestry 



Function 



Epithelium. 

Ectoderm 
Entoderm 
Mesoderm (rarely) 

Protective 

Secretory 

Absorptive 

Permit exchange of gases 

Motion 

Nervous 



Morphological 
Character 



Simple and 
Stratified 
Squamous 
Columnar and 
Polyhedral shaped cells 



Endothelium. 

Mesoderm 

Reduction of friction 



Always in a single 
layer 



Always squamous 



What is meant by the ancestry of a tissue? 

Its origin in the blastoderm. 

What is the function of connective tissue? 

Connective tissue enters into the formation of the structure 
to make a supporting framework; especially where great 
strength is required. Blood vessels, nerves and lymphatics 
are always carried in connective tissue. 

What is the structure of capillaries? 

Capillaries are the ultimate radicles of the vascular 
(arterial) system, and consist of a continuation of the lining 
of those vessels; being made of a single layer of endothelial 
cells, united by a small amount of intercellular cement 
substance. 

What cells form dentine? 

The odontoblasts. 



PHYSIOLOGY. 



Give the sources of saliva and its chemical functions 
and otherwise. 

Saliva is the secretion of the parotid, submaxillary and 
sublingual glands. It contains a ferment, ptyalin, which 
converts starch into maltose. The saliva facilitates speech 
by moistening the mucous membrane of the mouth; and on 
account of its contained mucin, facilitates deglutition by 
lubricating the bolus of food. By dissolving some of the 
solids in the food it allows them to be tasted. 

Where and how are the products of digestion finally 
incorporated into the tissues? 

The digested food is absorbed mainly by the villi of the 
small intestines. The water, soluble salts, glucose and pep- 
tones are passed through the columnar epithelium of the 
villi into the capillaries. These capillaries are radicals of 
the portal vein, and through this vein the products are 
carried to the liver. The blood of the liver passes out 
through the hepatic vein into the inferior vena cava and 
thus into the general circulation. The peptones during their 
passage through the columnar epithelium are converted into 
albumens and globulins. The digested fat passes through 
the columnar epithelium of the villi into the central lym- 
phatic vessel or lacteal. These lacteals carry the absorbed 
fats to the thoracic duct, which in turn empties them into 
the left sub-clavian vein, and thus into the general circulation. 

Describe the physiological process that takes place in 
the kidneys. 

The kidneys are compound tubular glands secreting urine. 
23 (353) 



354 PHYSIOLOGY. 

The tubules commence in the Malpighian corpuscles in the 
cortex. After leaving these the tubules become convoluted, 
then pass down as the loops of Henle, again become con- 
voluted, and finally empty into the collecting tubules. The 
convoluted portions are lined with rodded epithelium, and it 
is by these cells that the urea is picked out of the blood. All 
the substances found in the urine are waste products cir- 
culating in the blood, and these the epithelium picks out 
from the blood. The one exception to this is hippuric acid 
which is formed by the kidney cells. 

Describe the stomach and its secretions. 

The stomach is the ovoid dilatation of the gastro-intestinal 
tract; and is a muscular sac lined inside with mucous mem- 
brane, and outside with a serous membrane. The food en- 
ters from the oesophagus at the cardiac orifice, and passes out 
into the duodenum at the pyloric orifice. The stomach has 
two curvatures, the upper, or lesser curvature, and the lower, 
or greater curvature. That portion of the stomach, lying 
towards the spleen and forming a part of the greater cur- 
vature, is called the fundus. The stomach has four coats : 
serous, or outer; muscular, of which there are three distinct 
layers, circular, longitudinal and oblique; submucous; and 
mucous, imbedded in which we have the tubular glands that 
secrete the gastric juice. 

The gastric juice is a limpid, acid secretion, specific gravity 
1005, containing salts, hydrochloric acid (.2%), and two fer- 
ments, pepsin and rennin. About ten pints are secreted 
daily. 

How is the skin kept moist and the cuticle pliable? 

The skin is kept moist by the sweat, and the cuticle pliable 
by the sebaceous secretion. 

What are the sources of heat in the body? 

Heat is produced in the body by katabolism, principally in 
the muscular and glandular tissues. 



PHYSIOLOGY. 355 

Trace the circulation of the blood once around its course 
beginning at the right auricle. 

The blood enters the right auricle from the superior and 
inferior vena cavas, thence through the right aurieulo-ven- 
tricular or tricuspid valve into the right ventricle, past the 
pulmonary semilunar valve into the pulmonary artery to the 
capillaries of the lungs; from the lungs it is carried back 
through the pulmonary veins to the left auricle, past the 
left auriculo-ventricular or mitral valve into the left ventricle, 
through the aortic semilunar valve into the aorta and its 
branches to the capillaries of systemic circulation, and from 
these it is carried back to the heart by the systemic veins. 

What is waste, and by wljat organs is it eliminated 
from the system? 

Waste is products of metabolism of no further use to the 
organism. Waste is eliminated by the lungs, kidneys, skin 
and intestines. 

In what various ways is the loss by waste restored? 

By food, water and respiration; the blood acting as a 
medium of exchange. 

Describe the mechanical process by which the blood re- 
ceives oxygen. 

The blood receives its oxygen in the lungs where the capil- 
laries containing venous blood are separated from the oxygen 
of the air by a single layer of pavement epithelium. Three 
factors are concerned in the absorption of oxygen: mechani- 
cal law of pressure of gases, chemical affinity between hemo- 
globin and oxygen, and the vital activity of the epithelium 
of the air vessels. 

By what special fluid is nourishment to the tissues de- 
livered, and how? 

By the circulating blood, by osmosis through the capil- 
lary walls. 



356 PHYSIOLOGY. 

Describe fully the preparation of pabulum for the blood. 

The starches are converted by ptyalin of saliva and amy- 
lopsin of pancreatic juice into maltose. 

Maltose and cane sugar are converted into glucose by the 
invertin of succus entericus. Caseinogen is converted into 
casein by the rennin of gastric juice, and the milk- curdling 
ferment of pancreatic juice. 

The proteids are changed into proteoses and peptones by 
the pepsin of gastric juice and the trypsin of pancreatic 
juice. Enterokinase of the succus entericus energizes the 
trypsin. 

The fats are split up into fatty acids and glycerine, saponi- 
fied and emulsified by the steapsin of pancreatic juice and 
by the bile. 

The digested food is then absorbed by the villi of the 
small intestines. The fats are carried by laoteals to the 
thoracic duct; and the glucose, water, soluble salts and pep- 
tones are carried by the portal vein to the liver, the peptones 
being changed into native proteids while passing through 
the epithelium of the villi. 

What is the medulla oblongata? Give a short de= 
scription. 

The medulla oblongata is that portion of the central nerv- 
ous system between the upper end of the spinal cord and 
the lower boundary of the pons varolii. 

It is pyramidal in shape with the base upward, and is 
about one inch long, three-fourths of an inch wide and 
half an inch thick. Anteriorly is seen the anterior median 
fissure, the olivary bodies, and the anterior pyramids. 

The posterior surface of the medulla forms part of the floor 
of the fourth ventricle, bounded on each side by the diverging 
posterior columns of white matter. Laterally we find emerg- 
ing the cranial nerves from the sixth to the twelfth inclusive. 

In structure we find that it is made up of gray and white 
matter. 

The gray matter is cut up into small masses by the motor 



PHYSIOLOGY. 357 

and sensory decussations. These masses of gray matter form 
the nuclei for most of the cranial nerves. 

Describe the mechanism of the heart. 

The heart is a hollow muscular organ divided into four 
cavities, two on the right side and two on the left. Between 
the two sides there is no communication. The right side 
receives venous blood and forces it into the pulmonary cir- 
culation. The left side receives arterial blood and forces 
it into the general, systemic or greater circulation. The 
two auricles, contracting simultaneously toward the end of 
ventricular diastole, force the blood into the ventricles. The 
ventricles then contract, the auriculo-ventricular valves are 
closed, and the blood is forced into the arteries. The ven- 
tricles then relax and the blood flows in from the auricles, 
the auriculo-ventricular valves being open. The blood tends 
also to regurgitate into the ventricles from the arteries, but is 
prevented by the closure of the semilunar valves. The heart 
has been likened to a force pump, but it is also a suction 
pump, for during diastole, there is a negative pressure in 
the ventricles due to the elasticity of the muscular wall tend- 
ing to produce a vacuum. 

As to the nervous mechanism of the heart, we find in the 
medulla the cardio-inhibitory and the cardio-accelerating 
centres. The efferent nerve from the cardio-inhibitory centre 
to the heart is the vagus or pneumogastric ; the efferent 
from the cardio-accelerator centre is the accelerator branch 
of the sympathetic system. These nerves end in ganglionic 
masses in the heart. 

There is also an afferent nerve from the heart called the 
nervous depressor of Cyon and Ludwig ; when there is danger 
of rupture of the heart from over-pressure, it is irritated and 
carries an impulse to the vasomotor centre that depresses its 
tonus and lowers the blood pressure. 

Describe the pancreas, and the character and functions 
of its secretion. 

The pancreas is a tongue-shaped organ about six inches 



358 PHYSIOLOGY. 

long, weighing about two ounces and situated back of the 
stomach. It is sometimes called the abdominal salivary gland. 

The duct enters the duodenum about an inch and a half 
below the pylorus. The bile duct joins with it just before it 
opens into the duodenum. 

The pancreatic juice is a transparent, viscid, alkaline fluid, 
specific gravity 1012. There are about eight ounces secreted 
daily. It contains salts, especially sodium salts and four 
ferments. Amylopsin converts starch into maltose. 

Trypsin converts proteids into peptones and even into 
lower bodies, leucin, tyrosin and arginin. 

Steapsin splits up the fats into fatty acids and glycerine. 
The fatty acids combine with the alkalies present to form 
soap and this aids the emulsification of the rest of the fat. 

There is also a milk-curdling ferment. 

The pancreas has also an internal secretion, as extirpation 
of the organ causes diabetes. 

In what way does the blood lose material? 

By osmosis through the capillary walls into the tissues; 
by excretion from the lungs, skin, kidneys and liver, and by 
osmosis into gastro-intestinal canal, as in the watery stool 
following saline cathartics. 

What is the cerebro=spinaI axis, and what is its function? 

The cerebro-spinal axis is that portion of the nervous sys- 
tem consisting of spinal cord, medulla, pons varolii, crura 
cerebri, basal ganglia, cerebrum and cerebellum. Its func- 
tion is to receive afferent impulses and to send out, as the 
result of these, efferent impulses, to keep the body in normal 
condition, and through the cerebrum presides over thought, 
volition and sensation. 

What is the purpose of the lymphatic system and how 
fulfilled? 

The liquid portion of the blood osmoses through the capil- 
lary walls into the tissue. This diluted blood plasma is 
called lymph. It bathes and nourishes the tissue and is 



PHYSIOLOGY. 359 

carried by the lymphatics back to the general circulation 
through the thoracic duct and right lymphatic duct. They 
also carry absorbed material as the fat from the intestines, 
into the general circulation. 

The secretion of some of the ductless glands is emptied 
into the blood through its lymphatics. The cells formed in 
the lymph glands become leucocytes. 

What chemical exchange is effected in the lungs dur= 
ing respiration? 

Oxygen is absorbed by the blood. Carbon dioxide, nitro- 
gen, water and very small quantities of organic volatile prin- 
ciples are thrown off. 

How is the normal temperature of the human body 
maintained? 

The normal temperature of the body is maintained at 
about 98.4° F., by the proper balancing of heat production 
and heat dissipation. The production and dissipation of 
heat are controlled by the thermoljaxic centers of the nerv- 
ous system. These include the thermolytic, thermogenic 
and thermo-inhibitory centres. 

Describe the process of deglutition and name the glands 
where secretions are an essential aid in the process. 

Deglutition is the act of swallowing or passing of the food 
from the mouth into the stomach. There are in this act 
three stages, buccal, pharyngeal and oesophageal. The first 
is voluntary, the last two are involuntary. 

The bolus of food is forced by the tongue from the mouth 
into the pharynx. The muscular wall of which contracting 
from above downward forces the bolus into the oesophagus. 
A peristaltic wave of contraction then forces the bolus 
through the oesophagus into the stomach. Thus the degluti- 
tion of solids is a peristaltic act. But liquids are squirted 
through the pharynx and oesophagus with bulb syringe ef- 
fect by contraction of the mylo-hyoid muscle. 

The centre of deglutition is in the medulla. Tt receives 



360 PHYSIOLOGY. 

afferent impulses through, the trifacial and glosso-pharyngeal 
nerves, and gives off efferent impulses through the inferior 
maxillary division of the trifacial and glosso-pharyngeal 
and vagus. 

The glands whose secretions aid deglutition are the sali- 
vary, especially the sub-maxillary and sublingual; also the 
mucous glands of the mucous membrane of the mouth, 
pharynx and oesophagus. 

Name the digestive secretions, mentioning the principal 
action of each upon food. 

Saliva, gastric juice, pancreatic juice, bile and succus en- 
terieus are the digestive secretions. 

Saliva converts starch into maltose. 

Gastric juice converts proteids into peptones, and case- 
inogen into casein. 

Pancreatic juice converts proteids into peptones, starch 
into maltose, splits up the fats into fatty acids and glycerine, 
and converts caseinogen into casein. 

Bile emulsifies fats and prevents excessive action of bacteria. 

Succus entericus converts maltose and cane sugar into 
glucose and energizes the trypsin. 

Give the apparent origin and general distribution of 
the pneumogastric nerve. Mention some of the organs 
whose action it influences. 

The superficial origin of the pneumogastric is from the 
groove on the lateral surface of the medulla between the 
olivary and restiform bodies. It is distributed to the 
pharynx, larynx, oesophagus, heart, lungs, stomach, and to 
the abdominal sympathetic system. It is the motor nerve 
to the pharynx; motor and sensory to the larynx; motor, 
sensory and respiratory to the lungs ; motor, sensory and 
secretory to the stomach; cardio-inhibitory to the heart, 
and secretory to the pancreas, motor and inhibitory to the 
intestines. 

Describe the liver, its secretion and the function thereof. 

The liver is the largest gland in the body, weighing about 



PHYSIOLOGY. 361 

four pounds, and measuring transversely about twelve inches, 
antero-posteriorly about seven inches, and at its posterior part 
is about three inches thick. 

It is situated principally in the right hypochondriac re- 
gion, but extends through the epigastrium into the left 
hypochondriac region. 

It is divided by five fissures into five lobes, the largest of 
which is the right lobe. The most important fissure is the 
transverse ; for through this the blood enters the liver through 
the portal vein and hepatic artery, and passes out through 
the hepatic vein. The bile also passes out through the 
hepatic duct through this fissure. 

The secretion of the liver is bile. 

Bile is a reddish-yellow, or reddish-green, alkaline, viscid, 
bitter liquid with a specific gravity of about 1020. There 
are about two or two and a half pints secreted daily. 

It contains among other substances bilirubin, biliverdin, 
taurocholate and glycocholate of sodium, cholesterin, mucin 
and inorganic salts. 

The bile neutralizes the acid chyme, precipitating the pep- 
sin; emulsifies fats, and aids in their absorption; increases 
peristalsis; it is a slight antiseptic; and contains waste pro- 
ducts thrown off by the liver. 

Mention the nutritive fluids of the body. 

Blood, lymph and chyle. 

What conditions affect the body temperature? 

All conditions affect the body temperature that destroy 
the balance between heat production and heat dissipation. 

Among these you have muscular exercise, digestion, pro- 
longed exposure to extremes of temperature, shock (mental 
or physical), hysteria, drugs (as antipyrin, chloral hydrate 
and atropine), toxins of bacteria, injection of peptones and 
ptomaines, irritation of any one of the thermotaxic centres. 

Give the composition of the pancreatic secretion. 

According to Halliburton you have 97.6% of water: 1.8% 



362 PHYSIOLOGY. 

of organic matter of which the most important are the fer- 
ments; and .6% inorganic salts, among which are sodium 
chloride, sodium phosphate and potassium chloride. 

Give the properties of pancreatic juice, and state its re= 
action. Where does the pancreatic juice enter the intestine. 

The pancreatic juice is a colorless, transparent, viscid, alka- 
line fluid with a specific gravity of 1012. It contains four 
ferments; trypsin, amylopsin, steapsin and a milk-curdling 
ferment. 

The pancreatic juice enters the intestine through an open- 
ing in the posterior surface of the duodenum about its middle. 

Give the composition of blood, and state the use of each 
component part. 

The blood is composed of sixty parts of plasma or liquor 
sanguinis, and forty parts of corpuscles. 

The plasma is the liquid portion and contains about ten per 
cent, of solid matter, of which four-fifths are proteids. The 
solid matter is made up of serum albumen, serum globulin, 
fibrinogen, salts, glucose, fats and extractives. 

There are two kinds of corpuscles, red and white. 

The red corpuscles are the more numerous, the propor- 
tion being seven hundred reds to one white. The principal 
substance in the red corpuscle is the hemoglobin. 

The white corpuscles have amoeboid movement, and have 
a phagocytic action. By their disintegration fibrin ferment 
is formed. 

The red corpuscles carry the oxygen to the tissues. 

The fibrinogen clots after leaving the vessel and thus 
stops bleeding. 

The plasma carries the absorbed food to the tissues and 
the waste products to the excretory organs. 

The blood also keeps the various parts of the body at a 
fixed temperature. 

The function of the blood plates is not known. 



PHYSIOLOGY. 363 

State the difference between the vasoconstrictor nerves 
and the vaso=dilator nerves. 

The vasoconstrictors, when stimulated, decrease the calibre 
of the arterioles by causing a contraction of the muscular 
fibres in the middle coat of the vessels. 

The vaso-dilators, when stimulated, increase the calibre of 
the arterioles by inhibiting or decreasing the tonus of the 
local vaso-motor ganglia in the muscular wall. 

Define voluntary muscle; involuntary muscle. Give ex- 
ample of each. 

The voluntary muscles are those under the control of the 
will, and are transversely striated. The biceps is an ex- 
ample of a voluntary muscle. 

The involuntary muscles are those not under the control 
of the will, and are not transversely striated. The muscu- 
lar coat of the arteries is an example. 

State the function of the hypoglossal or sublingual nerve. 

It is the motor nerve of the tongue and the muscles con- 
nected with the hyoid bone. 

What special centers exist in the medulla oblongata? 

Deglutition, salivation, mastication, vomiting, diabetic, 
cardio-inhibitory, cardio-accelerator, vasomotor and re- 
spiratory. 

What is the function of the cerebrum? 

The cerebrum is the center of volition, sensation and 
ideation. 

What is the difference between proteid and amyloid 
foods? 

Proteids contain carbon, hydrogen, oxygen, nitrogen and 
sometimes phosphorus. 

The amyloid foods contain carbon, hydrogen and oxygen ; 
the last two elements in the proportion to form water ; and in 
the molecule, six atoms of carbon or a multiple of six. 



364 PHYSIOLOGY. 

The body can form amyloids from proteids, but cannot 
form proteids from amyloids. 

What is meant by flexion and extension of muscle? 

By flexion is meant the shortening or contraction of the 
muscle. 

The relaxation or lengthening of the muscle is called 
extension. 

Give the location of the stomach. State the work ac= 
complished by the stomach. 

It is situated in the front part of the upper abdomen in 
the epigastric region with its pyloric end a little below and 
to the right of the xiphoid cartilage, and its fundus pro- 
jecting over into the left hypochondrium. 

The stomach changes the proteids into peptones, curdles 
milk, and liquefies fats. 

Describe the stomach and its movements during 
digestion. 

The stomach is an irregularly ovoid, muscular sac, lined 
inside with mucous membrane, and outside with serous mem- 
brane. It is the dilated portion of the gastro-intestinal tract 
between the oesophagus and small intestine. The stomach 
holds, when full, about three pints. It has two openings, the 
cardiac, through which the food enters the stomach, and the 
pyloric, through which the food leaves the stomach. It has 
two curvatures, the upper or lesser and the lower or greater. 
The portion of the greater curvature lying toward the spleen 
is called the fundus. 

When the food reaches the stomach the two orifices close 
tightly like sphincters; the muscular wall also contracts down 
upon the food, and by means of the three muscular layers 
keeps the food in constant motion. Thus it brings fresh 
portions constantly to the surface to be acted upon by the 
gastric juice. A current passes down the fundus and greater 
curvature to the pylorus and back along the lesser curvature. 
After an hour of gastric digestion, the tightly closed 



PHYSIOLOGY. 365 

pylorus gradually relaxes, allowing some of the liquid chyme 
to enter the duodenum. Finally, at the end of three or 
four hours, even the more or less solid undigested portion 
is allowed to escape and enter the duodenum. 

Describe the alveolar process and state how it is 
developed. 

The alveolar process is made of an inner plate and an 
outer plate which are of compact osseous tissue. Between 
these plates there is a cancellous structure which is hollowed 
out into compartments for the different teeth. 

The alveolar process is of mesoblastic origin, being formed 
by the osteoblasts of the periosteum. As the permanent 
teeth form, the process is somewhat rebuilt to accommodate 
them. 

What is the epiglottis? 

The epiglottis is one of the single cartilages of the larynx. 
It is found at the base of the tongue and on the anterior 
edge of the upper opening of the larynx. 

Describe (a) the arterial system, (b) the capillary 
system. 

The arteries are tubes that carry the blood from the heart 
to the capillaries. The systemic arteries commence in the 
aorta which divides and subdivides. The cross-section of 
the aorta is much less than the combined cross-section of the 
arterioles. The arteries have three coats. The intima con- 
sists of a layer of endothelial cells on a basement membrane, 
and numerous yellow elastic fibres; the media consists prin- 
cipally of involuntary muscular fibres, arranged circularly, 
which are controlled by the local vasomotor ganglia; the ad- 
ventitia consists principally of areolar tissue containing some 
elastic fibres. The yellow elastic fibres are comparatively 
more abundant in the large arteries; the muscular more 
abundant in the arterioles. 

The capillaries are small tubes consisting of a single layer 
of lance-shaped endothelial cells. They connect the smallest 



366 PHYSIOLOGY. 

arteries with the smallest veins. They are about one-thirtieth 
of an inch long, and of sufficient calibre to allow a red 
corpuscle to pass through. 

How is bone nourished? 

Bone is nourished by the blood through the nutrient artery 
circulating in the marrow and Haversian canals. It is also 
nourished by the periosteum. 

State the importance of the blood to the body. 

The blood carries the food and oxygen to the tissues, and 
carries the carbon dioxide and other waste products from 
the tissues to the excretory organs. 

It is also by the circulation of the blood that the tem- 
perature of the various parts of the body is equalized. 

State the influence of posture on the action of the heart. 

There is an increase of nine to sixteen pulse beats when 
one rises from a reclining to a standing posture; the volume 
and force of the pulse increases at the same time. The effect 
of the sitting posture is intermediate between the two. 

Mention three inorganic substances found in the body. 
State in what part of the body each is found. 

Hydrochloric acid in the gastric juice. 
Sodium chloride in blood. 
Calcium carbonate in bone. 

What is the difference in function between the right 
and left sides of the heart? 

The right side receives venous blood and forces it through 
the pulmonary circulation. 

The left side receives arterial blood and forces it through 
the systemic or greater circulation. 

Describe the physiological action of (a) saliva, (b) gas= 
trie juice, (c) pancreatic juice. 

The ptyalin of saliva converts starch into maltose. 
The rennin of gastric juice changes caseinogen into casein 
and pepsin in an acid medium converts proteids into peptones. 



PHYSIOLOGY. 367 

As to pancreatic juice, trypsin in an alkaline solution con- 
verts proteids into peptones or even into lower bodies, leucin, 
tyrosin and arginin. It also changes some of the albuminoids 
into peptone-like bodies. Amylopsin converts starch into 
maltose. Steapsin splits up the fat into fatty acids and 
glycerin. The milk-curdling ferment curdles milk. 

State the function of each of the following muscles: 
(a) temporal, (b) masseter, (c) occipito=fronta!is, (d) 
orbicularis palpebrarum, (e) orbicularis oris. 

The temporal and masseter draw the lower jaw upward and 
are muscles of mastication. 

The occipito-frontaJis moves the scalp and raises the eye- 
brows. It is a muscle of expression. 

The orbicularis palpebrarum is the sphincter muscle of 
the eyelid ; and is also used as a muscle of expression. 

The orbicularis oris is the sphincter of the mouth. It is a 
muscle of expression ; and its contraction will carry the food 
backward into the oral cavity. 

State the normal pulse at each of the following ages: 
One year; ten years; fifty years. 

One year it is 115 to 120. 
Ten years it is 80 to 90. 
Fifty years it is 70 to 75. 

Why is blood light in the arteries and dark in the veins? 

Oxyhemoglobin found in the arteries is a lighter red than 
the deoxidized hemoglobin found in the veins. 

Is the natural condition of saliva alkaline or acid, and 
how is it tested? 

It is alkaline, and is tested with litmus or phenolphthalein. 

What is the normal temperature of the surface of the 
body? 

Very variable. The axillary temperature is about 98 de- 
grees Fahr. 



368 PHYSIOLOGY. 

Define assimilation. 

Assimilation is the conversion into protoplasm of the nutri- 
ent material or food ingested. 

State the use and importance of (a) perspiration, (b) 
bathing. 

By the evaporation of perspiration the body is kept at a 
fixed temperature. The perspiration carries off waste pro- 
ducts, keeps the skin pliable, and when need exists, relieves 
the kidneys of work. 

Bathing cleanses the external surface, stimulates the func- 
tion of the skin, and increases the general tone of the body. 

State the object of respiration. 

By the act of respiration oxygen is taken into the blood, and 
carbon dioxide, small quantities of nitrogen, water and some 
organic volatile substances are thrown off from the body. 

In some animals the evaporation of water, and thus dissi- 
pation of heat by frequent respirations, is quite marked. 

Describe the movements of the heart. 

The two auricles contracting, force the blood through the 
auriculo-ventricular orifices into their corresponding ven- 
tricles. These in turn contracting, force the blood past 
the semilunar valves into the pulmonary artery and aorta. 
The blood is prevented from regurgitating into the auricles 
during systole by the closure of the auriculo-ventricular 
valves. The ventricles then relax to be refilled with blood 
from the auricles. At the same time the semilunar valves are 
closed by the blood attempting to regurgitate from the arteries. 

During ventricular systole the heart becomes shorter and 
more globular, the base being forced down by the recoil 
from the forcing of the blood into the aorta. The heart 
rotates a little . during systole. 

Give the mechanical uses of saliva. 

Saliva assists in deglutition, in mastication, in speaking 
and in taste. 



PHYSIOLOGY. 369 

In what way does absorption of food occur? 

Most of the food is absorbed by the villi in the small 
intestines. 

Two factors are concerned in absorption, — osmosis and 
vital activity of the columnar epithelium of the villi. 

The soluble salts, glucose, water and peptones are carried 
by the capillaries through the portal vein to the liver and 
from here into the general circulation. 

The fat is carried by the lacteals to the thoracic duct, and 
through it into the left subclavian vein. 

What is the function of the liver? 

The liver secretes bile; it forms glycogen, urea, uric acid 
and conjugated sulphates. Some of the red corpuscles are 
formed and others destroyed in the liver. The liver also 
destroys some poisons in the circulating blood. 

What are the functions of the muscles? 

The muscles move the various parts of the body, and pro- 
duce most of the heat necessary to keep the body at the 
normal temperature. 

Give the symptoms of insufficient oxygen in the blood. 

Dyspnoea, cyanosis, increase of blood pressure, and finally 
exhaustion with decrease of blood pressure, weak, flabby pulse, 
irregular, shallow breathing, convulsions and death. 

Describe the sympathetic nervous system, and state 
its functions. 

The sympathetic nervous system consists of a double chain 
of ganglia extending from the base of the skull to the coccyx 
along the anterior surface of the vertebral column. These 
ganglia are connected by intervening nerves. Besides this 
double chain of ganglia there are three large plexuses of 
fibers and ganglia (cardiac, solar and hypogastric) and numer- 
ous smaller plexuses. Proceeding from the plexuses are 
numerous nonmedullated nerve fibres. 

The sympathetic system controls the movement of the ab- 
24 



t/ 



370 PHYSIOLOGY. 

dominal viscera, and contains the vasomotor nerves and the 
cardio-accelerator. 

Describe the physiologic action of alcohol. 

Alcohol in small doses is a stimulant to the cerebrum, re- 
spiration, heart, and gastric mucous membrane. In large 
doses it is a depressant to cerebrum, respiration, heart, vaso- 
motor system and gastric mucous membrane. It interferes 
with nutrition and causes a fall in temperature. 

Mention the valves of the heart and give their location. 

The mitral valve is located at the left auriculo- ventricular 
orifice. 

The tricuspid valve is located at the right auriculo-ven- 
tricular orifice. 

The aortic semilunar valve is located between the left ven- 
tricle and aorta. 

The pulmonary semilunar valve is located between the 
right ventricle and pulmonary artery. 

Name five of the principal elements of the body. 

Carbon, hydrogen, oxygen, nitrogen and sulphur. 
Define function. 

Function is the normal activity of an organ or group of 
organs. 

State (a) the normal temperature of an adult; the nor= 
mal pulse of an adult. 

Normal temperature is 98.4 degrees Fahr. 
Normal male adult pulse is 72 per minute. 

State why blood does not coagulate within the blood 
vessels. 

The blood does not coagulate on account of its contact 
with the endothelium of the intima. 

Describe the origin and fate of the red corpuscles. 

In embryonic life the red corpuscles are first formed in the 
Islands of Pander, later by the liver and spleen. After birth 



PHYSIOLOGY. 371 

the red corpuscles are formed in the liver and spleen and 
the red marrow of bones, especially of the ribs. 

They are probably destroyed in the liver and spleen. 

How does the blood coagulate? 

Fibrinogen, a proteid dissolved in the plasma, when acted 
upon by fibrin ferment in the presence of calcium salts is 
changed into fibrin. The clot consists of this insoluble fibrin 
in-the meshes of which are the corpuscles. The fibrin ferment 
is formed by the disintegration of the white corpuscles. 

Where and how is the blood changed from arterial to 
venous, from venous to arterial? 

By the process of osmosis, the oxygen passes out through 
the capillary walls into the tissues and carbon dioxide passes 
into the capillaries ; thus it is changed from arterial to venous 
in the capillaries of the tissues. 

The venous blood is forced by the right ventricle into the 
pulmonary capillaries where the blood is separated from the 
atmospheric air by only the capillary wall and the squamous 
epithelium of the air cells. 

There are three factors concerned in the exchange of the 
respiratory gases or changing the venous blood into arterial 
blood. The first is the physiological law of pressure of gases ; 
the second, chemical affinity between hemoglobin and oxygen ; 
and third, the selective vital activity of the epithelial cells 
of the air vesicles. 

State the effects of starvation on the human body. 

The bodily weight gradually decreases and the temperature 
becomes subnormal. The fats are used up first, followed 
finally by the proteids, especially of the muscles. The amount 
of urea excreted is first decreased; but as the increased oxi- 
dation of proteids begins, the urea is increased. Finally 
death ensues from exhaustion. 

The heart and central nervous system lose but little in 
weight. 



372 PHYSIOLOGY. 

Give the physiological properties and the chemical com- 
position of gastric juice. 

Gastric juice is a limpid acid liquid with a specific gravity 
of about 1005. 

It is composed of about 99.5% water and .5% solid. The 
bulk of solids is made up of pepsin, rennin, and hydro- 
chloric acid. Of the hydrochloric acid there are about two 
parts to the thousand. 

State the effects of battery currents on the normal 
human nerves. 

The faradic current stimulates them. 

A nerve during the passage of a constant current through 
it, is said to be in a state of electrotonus. There is an in- 
crease of excitability at the negative pole or kathode, and 
decrease of excitability at the positive or anode. 

How is the process of nutrition carried on? 

The blood receives the digested and absorbed food and also 
the oxygen from the lungs. It carries these products to the 
tissues which take out what they need. The blood receives 
the waste and carries it to the various excretory organs. The 
lymphatics also carry some of the waste from the tissues and 
empty it into the venous blood. 

How does lime or other inorganic matter find its way 
into the blood? 

Lime and other inorganic matter enter the body in the 
food and drinking water, and being absorbed by the villi of 
the small intestines are carried by the portal vein to the liver 
and then into the general circulation. 

Describe the structure and give the functions of the 
veins. 

The veins have three coats : The inner, composed of a layer 
of endothelial cells and elastic fibers; the middle, composed 
principally of involuntary muscular fibers, and the outer, com- 
posed of areolar tissue with numerous yellow elastic fibers. 

Many of the veins, especially those of the extremities, con- 
tain valves which help the movement of the blood within them. 



PHYSIOLOGY. 373 

The veins carry the blood from the capillaries to the heart. 
They all contain venous blood except the pulmonary veins 
which contain arterial blood. 

State the characteristics of the parotid and submaxillary 
glands. 

The parotid secretion is thin, watery, poor in solids (.3% 
to .5%) contains no mucin, and has excellent penetrating 
powers. 

The submaxillary secretion on account of containing a 
quantity of mucin, is ropy, contains 2% to 2.5% solids, is of a 
greater specific gravity, and is excellent for aiding deglutition. 
The mixed saliva has a specific gravity of about 1005, is alka- 
line, and contains especially ptyalin, potassium sulphocyanide, 
mucin, sodium chloride and other salts. 

Of what two great groups of substances is the body 
composed? 

Organic and inorganic. 

Mention the organs that compose the respiratory 
apparatus. 

The respiratory apparatus consists of the nose, pharynx, 
larynx, trachea, bronchi and air vesicles ; also of muscles mov- 
ing the thorax, the diaphragm, the nerves (afferent and ef- 
ferent) and the respiratory center in the medulla. 

What are the three kinds of digestion? 

The three kinds of digestion are that of proteids, of carbo- 
hydrates and of fats. 

What are the direct sources of the heat of the body? 

The most of the heat of the body is produced by katabolic 
changes, especially oxidation, taking place in the muscular 
and glandular tissues. 

Describe the parotid gland and give its function. Give 
location of the parotid gland. 

The parotid gland, the largest of the salivary glands, lies be- 
low and in front of the ear. The gland empties its secretion 



374 PHYSIOLOGY. 

by Stenson's duct into the mouth through an opening in the 
mucous membrane, opposite the second upper molar tooth. 
It is a compound racemose gland composed of acini lined 
with polyhedral cells resting on a basement membrane. Un- 
der this is a close network of capillaries. The parotid secretes 
saliva. 

State the functions of dental pulp. 

The dental pulp nourishes the dentine. The odontoblasts 
which it contains form the dentine. The pulp contains nerves 
which give sensation to the tooth and thus protects it 
indirectly. 

How many pairs of cranial nerves are there? What 
nerves supply the teeth? 

There are twelve pairs of cranial nerves. 
The teeth are supplied by the superior and inferior maxil- 
lary divisions of the trifacial nerve. 

On what particular phenomena does the study of physio- 
logy depend? 

Physiology is the study of the phenomena of living 
organisms. 

How does alcohol affect digestion? 

In small doses by its irritant action on the mucous mem- 
brane it causes an increase in secretion of gastric juice. 
Large doses retard digestion, especially that of the stomach. 

In what organs is the blood changed? 

It is changed in all the organs except the heart, but es- 
pecially in the liver, kidneys, lungs, spleen, bone-marrow 
and skin. 

What per cent, of the weight of the body is water? 
State the function of water in the body, and how it is 
eliminated from the body. 

About 75% of the body weight is water. 
In all the fluids of the body, water acts as a general sol- 
vent, being necessary to secretion and the carrying of nutri- 



PHYSIOLOGY. 375 

tion to and the waste products from the tissues. By its 
evaporation it dissipates large quantities of animal heat. 

It is eliminated from the body by the kidneys, sweat 
glands, lungs and in feces. 

What set of muscles gives the horizontal motion to the 
inferior maxillary? 

Internal and external pterygoids. 
Define afferent and efferent nerves. 

Afferent nerves carry impulses from the periphery to the 
central nervous system. 

Efferent nerves carry impulses from the central nervous 
system to the periphery. 

Name three kinds of food from which starch is derived, 
and give the percentage of starch in each. 

Potatoes 23.7%. 

"Wheat 70%. 

Rice 84.5%. 

What is the function of the gustatory nerve? 

The gustatory nerve is the nerve of taste. 
What is casein, and where is it found? 

Casein is a coagulated proteid found in curdled milk and 
cheese. 

How does the blood circulate through the heart? 

The blood passes from the superior and inferior vena cava 
into the right auricle, which contracting, forces it through 
the tricuspid valve into the right ventricle. The right ven- 
tricle then contracts and forces the blood past the pulmonary 
semilunar valve into the pulmonary artery. This artery 
carries the blood to the lungs, and from these it is carried back 
through the pulmonary veins into the left auricle. Then it 
passes through the mitral valve into the left ventricle, which, 
contracting, forces the blood into the aorta. 

What is the function of the nervous system? 

The function of the nervous svstem is to carry afferent im- 



376 PHYSIOLOGY. 

pulses from the periphery and as a result of such impression 
to send out efferent impulses, to receive impressions, to pre- 
side over thought, and to control the action of the various 
parts of the body. 

How may coagulation of blood be hastened? 

It may be hastened by increasing the temperature, injury 
to the vessel walls, contact with foreign matter and oxygen, 
agitation and addition of calcium salts. 

State how many of the seventy known elements form 
a practical part in making up the animal tissue, and men- 
tion the four most important of these elements. 

There are sixteen to nineteen elements found in the tissues 
of the body. Of these the most important are carbon, oxygen, 
hydrogen and nitrogen. 

What is food? State why milk is so nearly a perfect 
food. 

Food is that which, taken into the body, nourishes the 
tissues or supplies heat. 

Milk is so nearly a perfect food because it contains all the 
chemical compounds necessary to life, that is, proteids, car- 
bohydrates, fats, salts and. water. 

What are proximate principles? 

Proximate principles are substances that enter into the 
composition of the body. 

Name three of the most important inorganic proximate 
principles, and state where they are found in the body. 

Calcium phosphate is found in bone. 
Sodium chloride is found in the blood. 
- AYater is found all through the body. 

Are inorganic ingredients of food necessary to sustain 
life? Why? 

They are necessary because they are indispensable constitu- 
ents of the structure of the body, — as calcium salts in bone; 
because the alkaline bases are necessary to neutralize the acids 



PHYSIOLOGY. 377 

formed by the proteid metabolism ; because they are necess- 
ary for digestion and absorption, and because water is the 
general solvent of the body. 

Describe the lymphatic system and give its function. 

The lymphatic system consists of lymph capillaries, of nu- 
merous thin-walled vessels lined with endothelium, of lym- 
phatic glands situated on these vessels, of the thoracic duct, of 
the lymphatics of the intestines called lacteals, and the spleen. 

The thoracic duct begins in a dilated extremity called the 
cisterna magna about the level of the second lumbar vertebra, 
and runs up along . the vertebral column emptying into the 
left subclavian vein. It receives the lymph from the lower 
extremities, abdomen, left lung, left arm and left face. The 
lymph of the right lung, right arm and right face is emptied 
through a small vessel into the right subclavian vein. 

The lymphatic glands are found along the course of the 
lymphatic vessels, and are composed of lymphoid tissue in the 
center of which are cells rapidly undergoing karyokinesis. 
The lacteals are the lymphatic vessels of the intestines and 
carry the absorbed fats from the villi to the thoracic duct. 

The lymphatic system carries back into the blood circula- 
tion the blood plasma that has osmosed through the capillary 
walls into the tissues. It also forms leucocytes and carries 
the absorbed fat from the intestines into the general cir- 
culation. The secretion of some of the ductless glands passes 
through the lymphatics into the blood channels. 

Describe the circulatory apparatus. 

The circulatory apparatus consists of the heart, arteries, 
capillaries and veins. 

The heart is a hollow, muscular organ, lined inside with 
the endocardium and outside w T ith the pericardium. It is 
pyramidal in shape, about 5% inches long, 3y 2 inches wide 
and weighs about ten ounces. It is divided into four cavi- 
ties, two auricles and two ventricles. The ventricles are 
the most important cavities, the left ventricle being throe 
times as thick as the right, ventricle. 



378 PHYSIOLOGY. 

The arteries are the vessels that carry the blood from 
the heart to the capillaries. They all contain arterial blood 
with the exception of the pulmonary artery. Histologically 
they consist of three coats. The intima or internal coat is 
composed of yellow elastic fibers lined internally with a 
layer of endothelium; the media or middle coat is made up 
mostly of involuntary muscular fibers running transversely 
to the long axis of the artery; the adventitia or external 
coat is composed of areolar tissue containing numerous yel- 
low elastic fibers. The vaso-motor nerves end in the ganglia 
in the muscular coat. The elastic fibers are found com- 
paratively more numerous in the larger arteries, and the 
muscular fibers in the arterioles. 

The capillaries are the small blood vessels connecting the 
smallest arteries with the smallest veins, and consist of a 
single layer of lance-shaped endothelial cells. The capil- 
laries on an average are 3^ of an inch long and 1-3000 of an 
inch in diameter. 

The veins are similar in structure to the arteries but the 
coats are not so thick. Some of the veins, especially those 
of the extremities, have valves which prevent the regurgi- 
tation of blood during muscular contraction. 

What disposition is made of gastric juice after serving 
its purpose in aiding digestion? 

The hydrochloric acid is neutralized by the alkaline bile 
and the pepsin is precipitated. 

Define endosmosis, exosmosis. 

Endosmosis is the passage of a liquid through a porous dia- 
phragm from without inward. 

Exosmosis is the passage of a liquid through a porous dia- 
phragm from within outward. 

Give the foramen of exit, principal branches of dis= 
tribution and function of the hypoglossal nerve. 

Anterior condyloid foramen ; branches of distribution a re : 
Meningeal, descendens hypoglossi, thyro-hyoid and muscular. 
It is the motor nerve of the tongue. 



PHYSIOLOGY. 379 

Give the functions of that part of the facial nerve which 
is distributed to the oral cavity. 

Influences the sense of taste, mastication and the secretion 
of the submaxillary and parotid glands. 

What is the function of the fifth pair of nerves? 

The fifth nerve is the sensory nerve to the face, oral 
and nasal cavity, and the motor nerve to the muscles of 
mastication. 

What anatomical structures are engaged when the food 
passes from the mouth to the stomach? 

The tongue, soft palate, constrictors of the pharynx, uvula, 
pharynx and esophagus. 

What noticeable change would appear if the seventh 
nerve were excised? 

Complete loss of motion of the muscles of expression of 
the face. 

Mention the difference between parotid and sublingual 
saliva. 

The parotid saliva is thin and watery, while the sublingual 
is thick and viscid, as it contains much mucin. More ptyalin 
is found in parotid saliva than in sublingual saliva. 

What muscles are most active in opening the mouth? 

Digastric, genio-hyoid, mylo-hyoid and platysma myoides. 

Give in the regular order the normal average age at 
which the deciduous teeth are erupted. 

C.I 5th to 7th month 

L. 1 9th " 11th " 

1st M 12th " 14th " 

Cuspids, 14th " 18th " 

2nd M 18th " 25th " 

Name the muscles concerned in the act of deglutition. 

Extrinsic and intrinsic muscles of the tongue, tensor palati, 
azygos uvuli, palato-pharyngeus. superior constrictor of 



380 PHYSIOLOGY. 

pharynx, middle and inferior constrictor of pharynx, also the 
muscular coat of the esophagus. 

What are the fluids of the mouth? Give their active 
principle and function? 

Saliva from the salivary glands, and mucus from the mucous 
glands. The active principle of saliva is ptyalin, that of 
mucus is mucin. The function of saliva is to soften and 
moisten the food and to convert starch into maltose. The 
function of the mucus is to keep the mucous membrane of the 
mouth moist. 

Give the period of eruption of the permanent teeth. 

1st M 6th to 7th year. 

C. I 7th " 9th 

L. 1 8th " 10th 

1st B. C 10th " 11th 

2nd B. C 11th " 12th 

Cuspids 12th " 13th 

2nd M 12th " 13th 

3rdM 16th " 25th 

Describe the two systems of nerves in the human body. 

The sympathetic nervous system consists of a double chain 
of ganglia anterior to the vertebrae, several large plexuses 
consisting of large ganglia and numerous nerve fibers and in- 
numerable smaller plexuses supplying the involuntary mus- 
cular tissue. The nerves of the sympathetic system are non- 
medullated. 

The cerebro-spinal nerves are medullated fibers given off 
from the cerebro-spinal axis. They are of two kinds. The 
efferent, supplying principally the voluntary muscular tissue 
and glands and afferent or sensory, carrying impressions from 
the various sense organs to the central nervous system. 

State how the nervous system influences digestion. 

The nervous system influences digestion by means of the 
various secretory nerves and their centres; by the motor and 
inhibitory nerves controlling the movement of the muscular 



PHYSIOLOGY. 381 

tissue of the gastrointestinal tract and through many af- 
ferent or sensory nerves starts innumerable reflexes. 

State the physiologic relation of the pneumogastric 
nerve to the stomach. 

The pneumogastric is the sensory, motor in great part, and 
secretory nerve to the stomach. It may also contain some 
inhibitory fibres to the muscular tissue 'of the stomach. 

Into what classes are proximate principles divided? 
Mention examples of each class. 

The proximate principles of the body are water, salts as 
sodium chloride, proteids as casein, carbohydrates as starch, 
and fats as olein. 

Describe the movements of the ribs during inhalation? 

During inhalation the ribs are raised anteriorly and ro- 
tated outward like the handle of a bucket laterally. They 
are fixed posteriorly to the vertebrae. 

Describe intestinal digestion. 

The partly digested acid chyme passes through the pylorus 
into the duodenum. The bile and pancreatic juice enter 
through a common duct into the duodenum. The glands of 
Brunner of the duodenal mucosa and the crypts of Leiber- 
kuhn of the intestines, empty their secretion into the lumen 
of the intestine. The bile neutralizes the acid chyme, pre- 
cipitating the pepsin, thus stopping gastric digestion. It also 
aids in the digestion of the fats. 

The pancreatic juice contains four ferments: the trypsin 
changes the proteids into peptones, the amylopsin changes the 
starch into maltose, the steapsin splits up the fats and a milk- 
curdling ferment changes the caseinogen into casein. The 
invertin of the succus entericus changes the maltose into dex- 
trose. The enterokinase energizes the trypsin, and erepsin 
breaks up the peptones into simpler bodies. We have also in 
the intestines microbic digestion with the formation of various 
gases, as hydrogen sulphide, carbon dioxide, aromatic bodies, 
as indol, phenol, skatol, etc. 



382 PHYSIOLOGY. 

State the function of the facial nerve. 

The facial nerve is the motor nerve to the muscles of ex- 
pression of the face. 

State the function of glycogen. 

The glycogen is used up principally by the muscular tissue 
to supply heat and mechanical energy. 

State where the absorption of proteids takes place. 

The proteids are absorbed principally through the villi 
of the small intestines. 

State how the act of inspiration is accomplished. 

Efferent impulses from the inspiratory centre are sent out to 
the various muscles of inspiration. The diaphragm contracts, 
its central tendon is lowered and the vertical diameter of the 
thorax is increased. The ribs are raised and rotated out- 
ward laterally, thus increasing the anterior, posterior and 
lateral diameters of the thorax. The air then rushes through 
the trachea into the lungs to fill up the partial vacuum thus 
produced. 

Describe the act of mastication. 

r ine act of mastication consists in the breaking up of the 
food and mixing it with saliva. This is accomplished by the 
teeth, assisted by the tongue and the muscles attached to the 
jaws and around the mouth. There are three classes of 
teeth; incisors or cutters, canines or tearers, and molars or 
grinders. 

What proportion of the weight of the body is blood? 
State with regard to blood (a) its specific gravity; (b) its 
reaction; (c) on what its color depends. 

About one-thirteenth of the body weight is blood ; its specific 
gravity is about 1055; reaction alkaline. The color depends 
upon its contained hemoglobin. 

Name the successive divisions of the alimentary tract. 

The divisions of the alimentary tract are the mouth, 



PHYSIOLOGY. 383 

pharynx, esophagus, stomach, small intestine (duodenum, 
jejunum and ileum), large intestine, (caecum, ascending, 
transverse and descending colon and sigmoid flexure), rectum 
and anus. 

What organs excrete waste and what does each thus 
remove from the system? 

The lungs remove the carbon dioxide, the skin removes ex- 
cess of water and small quantities of organic material and 
supplements the action of the kidneys. The kidneys remove 
the urea, the phosphates and sulphates from the proteid kata- 
bolism, water, and excess of salts ingested in the food. The 
intestines remove waste thrown off by the liver, refuse of 
digestion and may at times supplement the action of the 
kidneys. 

State approximately the amount of saliva and of gastric 
juice secreted during 24 hours. 

There is secreted daily about two pints of saliva and ten 
to twelve pints of gastric juice. 

Are the albuminous matters solid or fluid? State where 
albuminous matters are found in the body. 

Albumens are solids but in the body are in solution. 
They are found all over the body. 

Give the composition of perspiration. 

The perspiration contains about one per cent, of solid mat- 
ter, two-thirds of which is inorganic (principally sodium 
chloride) and one-third of organic (principally fats and 
fatty acid) with a little urea and epithelial debris. 

Describe the action of the nervous system on the sali= 
vary glands. 

There is a centre in the medulla that controls the secretion 
of saliva. The two efferent nerves from this centre are the 
auriculotemporal for the parotid and the chorda tympani for 
the sub-maxillary and sublingual glands. 

The terminals of many afferent nerves when stimulated 



384 PHYSIOLOGY. 

will cause a reflex secretion of saliva. Among these are the 
trifacial terminals in the mucosa of the mouth, vagus ter- 
minals in gastric mucosa, gustatory terminals in the tongue, 
olfactory in the nose, and even the terminals in the uterine 
mucosa. 

State the effect produced by the blood while passing 
through the muscles. 

The blood while passing through the muscles becomes venous, 
giving up the oxygen of the oxyhemoglobin, supplies nour- 
ishment to the muscle, carries off waste, principally in the 
form of CO,. 

State the function of the salivary glands. 

The salivary glands secrete a fluid containing a principle 
called ptyalin which converts starch into sugar. It also aids 
in moistening the bolus of food, thus aiding the digestion. 

Describe metabolism. 

Metabolism is the chemical change going on in organized 
tissue. 

Describe secretions. State how the process of secre= 
tion is carried on. 

Secretions are those products of activity of the epithelium 
of glandular tissue that are of further use to the organism. 
The glands receive their nourishment from the blood. The 
supply of blood is under the control of the vaso-motor system. 
The cells under the stimulus of impulses through the secre- 
tory nerves, or as in the case of the pancreas, from substances 
circulating in the blood (secretin) pick out certain ele- 
ments of the blood and form new substances, which are 
thrown out into the lumen of ducts of the gland. In the 
ductless glands, these products are thrown into the blood 
vessels directly or indirectly, through the lymphatic system. 

State the character of the food absorbed by the lym= 
phatic circulation and its manner of reaching the blood 
circulation. 

The fats are absorbed through the villi, carried by the 



PHYSIOLOGY. 385 

lacteals to the receptaculum chyli, thence through the thoracic 
duct into the left subclavian vein. 

Define nerves of special sense. 

The nerves of special sense are the nerves carrying the 
afferent impulses from the various peripheral sense organs 
to the central nervous system. 

Describe reflex action. Give an example of a reflex 
action that is automatically performed. 

A reflex action is an afferent impulse followed by an efferent 
impulse and is independent of volition. 

A blow on the solar plexus will cause a reflex slowing or 
stoppage of the heart. 

Describe a ganglion. 

A ganglion is a mass of nerve cells some distance from the 
central cerebro-spinal axis, and has nerve fibers entering and 
leaving it. 

Mention the organs necessary for a sensation. 

For a physiologic sensation there must be a peripheral sense 
organ, the sensory nerve or pathway from it and the cerebral 
center to receive the impression. 

State the average amount of sweat excreted in 24 hours. 
Is this excretion necessary to sustain life? Give reasons. 

The average amount of sweat per day is two pints. 
It is a necessary excretion, as through the sweat, most of 
the heat produced in the body is dissipated. 

Give the chemical composition of muscle. 

Muscle contains the proteids, myosinogen, myoalbumen and 
myoglobulen, small quantities of glycogen and inosite, extrac- 
tives as urea, creatin and creatinin, a red coloring matter, 
myokematin and inorganic salts, especially potassium phos- 
phate. It is normally alkaline, but when fatigued becomes 
acid, from the formation of sarcolactic acid. 
25 



386 PHYSIOLOGY. 

■■ Describe the structure and state the functions of the 
skin. 

The skin consists of the cutis vera, formed of dense fibrous 
tissue, the superficial layer being raised into numerous papillae. 
This is the vascular layer of the skin. The end bulbs of the 
sensory nerves are found here also. Covering the cutis vera 
is the epidermis, formed of numerous layers of epithelium. 
There are four strata of the epithelium: — the outer, horny, 
or stratum corneum ; the stratum lucidum ; the stratum gran- 
ulosum, and the inner or stratum mucosum. 

The function of the skin is to protect the underlying soft 
parts from injury and drying, to protect the sense corpuscles, 
and through the sweat glands and blood vessels to dissipate 
heat. The hair, an appendage of the skin, protects some of 
the organs from cold, the brain from shock and prevents fric- 
tion, as in the arm pits. 

What causes the beat or pulsation of the heart? 

The rhythmic activity of the heart is due to intrinsic property 
of the heart muscle. According to Loeb it is controlled by 
'the proper balancing of the ions of sodium, calcium and 
potassium. 

Has blood plasma an alkaline or an acid reaction? 
Give reasons. 

The blood plasma is alkaline in reaction due to the dissolved 
alkaline salts, especially sodium carbonate and phosphate, 
that it contains. 

Describe by diagram or otherwise a transverse section 
of the spinal cord. 

The spinal cord is a rounded mass of white matter, imbedded 
in which is a central mass of grey matter, arranged like the 
letter H. The white matter consists of nerve fibers and the 
grey of nerve cells. These are held together with neuroglia. 
^The projections backward of grey matter are called the pos- 
' terior horns. These come to the surface of the cord postero- 
laterally. Here the posterior roots or sensory nerves enter 
the cord. 



PHYSIOLOGY. 387 

The projections forward of grey matter are called the 
anterior horns. Fibers starting here emerge from the antero- 
lateral surface of the cord. In the median line there is the 
anterior median fissure, projecting about one-third of the 
distance into the cord, and the posterior median fissure, pro- 
jecting about half the distance into the cord. The white mat- 
ter between the posterior horn and the posterior median fissure 
is called the posterior column and is divided into the two 
tracts of Goll (median) and Burdach. Between the anterior 
horn and the anterior median fissure is the anterior column, 
divided into the direct pyramidal (median) tract and the 
anterior ground bundle. The white matter between the two 
horns is called the lateral column and is divided into five 
tracts; the crossed pyramidal tract, triangular in shape and 
found close to the posterior horn, then along the periphery 
of the cord from behind forward we have the direct cere- 
bellar, anterior lateral ascending cerebellar (Grower's) and 
anterior lateral descending cerebellar (Lowenthal's) and 
deep in the lateral column is the deep lateral tract. 

In the grey matter there are two especially well marked 
columns of grey cell, one situated at the base of the posterior 
horn (Clark's column) the other, the intermedio-lateral 
column, between the two horns laterally. 



HYGIENE. 



Mention eight satisfactory disinfectants and give in- 
dications for their use. 

Formaldehyde (1 pound for every 1000 cu. ft. of space), 
sulphur (3 pounds for every 1000 cu. ft. of space) or 
bleaching powder (3 pounds for every 5000 cu. ft. of space) 
to fumigate a room. If sulphur or bleaching powder are 
used, it is necessary to steam the room before beginning to 
fumigate. Chloride of lime to disinfect excrementitious mat- 
ter from typhoid fever, cholera, dysentery, etc. Carbolic acid 
(5% solution) or moist heat (steam and boiling water) to 
disinfect clothing. Bichloride of mercury or permanganate 
of potassium and oxalic acid to disinfect the skin. 

What are the most common sources of infection in 
diphtheria? 

By direct contact with the sputum or shreds of membrane 
from the patient. By inhaling the air in the vicinity of 
the patient. By fomites, clothing, books, drinking- 
cups, etc. 

What conditions are essential to a good water supply? 

Purity at its source, and adequate subsequent protection 
from contamination. 

Describe the hygiene of the mouth and teeth. 

The teeth should be cleansed after each meal and on rising 
in the morning, and foreign matter between the teeth should 
be removed. Acidity of the saliva may be counteracted by 
weak alkaline mouth washes. 

(389) 



390 HYGLEXE. 

What methods would you suggest for the hygienic care 
of the skin? 

Simple foods; avoiding constipation; daily exercise in the 
open air; plenty of sleep (at least eight hours daily) ; fre- 
quent warm baths and a cold sponge bath on rising each 
morning. 

Name the kinds of food and the quantity of each for the 
daily use of the normal man. 

4.5 ounces of proteids; 3.5 ounces of fats; 14 ounces 
of carbohydrates; 1 ounce of salts (Moleschott) . Or 118 
grains proteids ; 56 grains fats ; 500 grains carbohydrates 
(Voit). These quantities represent dry foods. If the diet 
is stated as so-called solid-food (not water-free) the above 
quantities must be doubled. 50 to 80 ounces of water in 
liquid form are also taken into the system. 

Describe in detail the process of disinfection by for» 
maldehyde (formalin). 

Make the room as near air-tight as possible by closing all 
openings and cracks before beginning the process of disinfec- 
tion. All mattresses, pillows, clothing, books, etc., should b© 
exposed as fully as possible to the action of the disinfectant. 
Place one pound of formalin for every 1000 cu. ft. of air 
space in a "Novy" generator. Start the rapid volatilizing 
of the formaldehyde and allow the room to remain closed 
for one day. 

What hygienic means should be employed by persons 
prone to " catch cold?" 

A cold sponge bath followed by brisk rubbing on arising in 
the morning; daily muscular exercise in the open air and a 
liberal (but not excessive) diet, largely of carbohydrates. 

What are the sanitary requirements of house plumbing? 

All pipes and connections, traps, etc., should be in view 
or easy of access. Each house must be directly connected by 
pipe with the common sewer. The pipes in the house must 



HYGIENE. 391 

be of iron with leaded joints or screwed couplings. The 
drainage pipes should be laid with a gradient of at least one 
inch fall to every four feet of length; the main house drain 
must be provided with a trap after it has been carried be r 
yond all house connecting pipes. Pipes from water closet 
fixtures, bath tubs, wash basins and sinks must have traps 
close to each fixture. Soil pipes must extend open for at 
least two feet above the roof and air must be admitted to 
the main trap upon its house-side. 

Describe a simple form of ventilating the sick-room. 

Place a wooden strip about three inches wide and as long 
as the window frame under the lower sash ; through the space 
between the top of the lower sash and the bottom of the 
upper, sufficient air will enter the room without producing 
a draught. 

What precautions should be taken in school rooms to 
protect the sight of scholars? 

Pupils should not sit facing the windows (the light should 
come from behind or over left shoulder) ; blackboards should 
not have a glossy surface or be placed between windows. 
The walls of the room should be of a neutral tint. Text 
books should be printed in clear, large type. Faulty pos- 
ture in reading and writing should be corrected by the 
teacher. If toilet accessories are supplied, no child suffering 
from an inflammatory disease of the eyes should be per- 
mitted the use of the general supply. Any imperfection in 
virion of a pupil should be reported to the parents. 

What are the chief sources of contamination to drink= 
ing water? 

The emptying of sewage into the stream from which the 
water supply is obtained; surface water in settled districts 
gaining entrance to the supply; sub-soil water, after passing 
through a filthy soil ; draining from places of burial ; and 
water which has dissolved poisonous minerals. 



392 HYGIENE. 

Describe the different methods of purifying drinking 
water. 

Sedimentation, occurring when collections of water remain 
at rest for a considerable time, removing, in part, at least, 
suspended matter. 

Sand nitration in which the water flows upon and through 
prepared beds of sand, gravel and broken stone, packed in 
separate layers, removes from it not only suspended matter, 
but also dissolved organic matters and bacteria through the 
action of air (oxygen) in the interstices of the filter material, 
and the action of saprophytic bacteria. 

Boiling water will free it of pathogenic bacteria and tem- 
porary hardness, but such water, after boiling, should be 
aerated to fit it for use. 

What do you understand by the " dry earth system " as 
applied to excrementitious matter? 

The container under the privy seat contains the dry earth, 
and after the use of the privy, fresh earth is always to be 
added to the receptacle. From time to time the contents are 
removed and buried or otherwise disposed of. 

Mention some of the results of tobacco smoking in 
growing school boys in respect to the circulation, air pas= 
sages, vision and mental application. 

It depresses the circulation and produces palpitation of 
the heart. It causes low grades of inflammatory processes in 
the upper air passages, catarrhal conjunctivitis, mental 
lethargy with inability to sustained mental application. 

What habits of school children tend to produce myopia? 

Reading of small or imperfect print; faulty positions while 
reading or writing in which the eyes are not far enough re- 
moved from the page. Reading or writing in insufficient 
light, or when fatigued. 

What should be the proper temperature for a living room 
in winter? 

72 c F. for old or weak persons; 65° F. for the young 
and vigorous. 









HYGIENE. 393 

What should be the diet of a child over two years of 
age? 

The food should consist principally of milk and bread, with 
rice, tapioca, some vegetables of easily digestible character 
and sparingly of fruit, preferably cooked; but little meat 
should be allowed and this preferably mutton. 

What is the most sanitary way of disposing of city 
garbage? 

Burn it, so that all noxious vapors are also consumed. 

Mention six desirable factors in the location of a resort 
for consumptives. 

Equable climate, high altitude, dry atmosphere, pure air, 
abundant sunshine and pine forests are climatic factors for 
consumptives. 

State the accepted belief in respect to the limitation of 
protection from vaccination. 

Five years, when revaccination should be attempted. Dur- 
ing a small-pox epidemic it is advisable to revaccinate all 
individuals who have not been vaccinated within two years. 

Mention some of the adulterations in preparations of 
ground coffee for sale in the shops. 

Chicory, peas, roasted cereals and legumes, date stones, 
acorns, sawdust, etc. 

What class of foods should predominate for persons over 
sixty years of age? 

Use eight-tenths the quantity of proteids that the vigor- 
ous adult requires; seven-tenths the quantity of carbo- 
hydrates ; and one and two-tenths times the quantity of fats. 

Which in your judgment is to be preferred in vaccin- 
ation, animal or humanized lymph, and why? 

Animal lymph, because in its preparation greater care may 
be taken to secure its freedom from deleterious additions. 



394 HYGIENE. 

Name some of the nuisances dangerous to health. 

Gases and dust of a poisonous or irritating nature arising 
from many .manufacturing industries. Collection of stag- 
nant water, garbage and animal excreta exposed to the air; 
leaking drains or sewers saturating the soil, or allowing the 
escape of gases. Industries giving rise to great noise or 
vibration in thickly settled communities. 

What is the best means for preventing the access of 
sewer gas in dwellings? 

Place a trap or water seal between the house drain and the 
sewer, and provide an air inlet pipe to open into the drain 
pipe between this trap and the house. A ventilation pipe 
should extend from the house drain to a point above the roof. 

Name the diseases the predisposition to which is greatly 
increased by the use of alcohol. 

Diseases of the heart and vascular system, the kidneys, 
brain and liver and of the respiratory system, particularly 
pneumonia and asthma. 

Name four diseases that are communicable to man 
through cows' milk. 

Typhoid fever, scarlet fever, cholera and tuberculosis. 

To what is indigestion from excessive tea drinking 
attributable? State a formula for the preparation of 
good tea. 

The indigestion is caused chiefly by tannin; also by 
theobromin. 

Pour one pint of boiling water over a dram of the dried 
tea leaves and allow it to stand, without applying further 
heat, for five minutes. 

Mention some of the advantages of carefully prepared 
artificial ice as compared with natural ice. 

It may be made from distilled water so as to be ab- 
solutely pure. It may be obtained in any size or shape and 
its texture is more uniform. 



HYGIENE. 395 

What precautions as to food and drink should be ob- 
served by those forced to work under the direct rays of 
the sun in summer weather? 

A small quantity of readily digestible food should be 
eaten before going to work. Liquids of a nonalcoholic charac- 
ter may be used liberally, provided perspiratory function is 
actively performed. Very cold drinks should be avoided. 
Meat should be largely excluded from the diet. 

What are the best methods of ventilating dwellings, and 
what sanitary principles are involved? 

The perflating action of wind should be utilized at least 
once each day for all rooms. One of the best methods em- 
ployed is the open fireplace, provided such fireplaces be sup- 
plied with properly constructed chimney exits. Instead of 
this plan, fresh air may be admitted through ventilators, or 
between the upper and lower window sashes. The object 
sought in these devices is to admit cold air above the heads 
of the occupants of the room so that the fresh air may pass 
through the upper portions of the room and become heated 
before reaching the occupants. The usual outlet for foul air 
is the chimney flue, but when this is not present, it may be 
replaced by an opening for the exit of air placed near the 
floor of each room. When the incoming air is not heated 
the outlet should be at the top of the room. During cold 
weather the rate or interchange of air should not be greater 
than sufficient to change the air of the room three times an 
hour. The air which enters should not have a greater velo- 
city than five feet per second or about 3.4 miles per hour. 

What hygienic precautions are necessary to insure 
healthy sleep? 

A well ventilated room, temperature about 60° F. Room 
and bed should be perfectly clean and the covers of the bed 
not too heavy. The head of the person should be slightly ele- 
vated. Noise and light should be excluded from sleeping 
apartments. 



396 HYGIENE. 

What deleterious gases accumulate in improperly venti- 
lated sleeping rooms? 

Carbon dioxid ; carbon monoxid, if rooms be heated ; hydro- 
gen sulphid; ammonium sulphid, and many gases of an or- 
ganic ammoniacal character. 

Does change in climate require any change in food; if so, 
what? 

Yes. In cold climates a greater quantity of food should 
be consumed than in hot climates. Food that is productive 
of the greatest number of heat units, as fats and meats, 
should be partaken of in cold climates. In hot climates the 
diet should consist almost entirely of well-cooked vegetables 
and ripe fruits; with the avoidance of alcoholic beverages. 

What are some of the dangers of the cold bath? 

In those of feeble circulation and at the two extremes of 
life, chilling of the surface of the body leading to internal 
congestion that may result in acute inflammation, particu- 
larly of the lungs, kidneys, stomach and bowels. Shock seri- 
ously affecting the heart ; and the production of a persistently 
lowered temperature of the body. 

What effect has ground air and water on the health? 

Ground air is always impure, being contaminated with 
bacteria, carbonic dioxid and often with more poisonous 
gases. It occasions various degrees of ill-health, varying from 
slight general malaise to one of the acute infectious diseases 
or tuberculosis. Ground water from near the surface of 
polluted soils may be noxious. It causes dampness of the 
walls of houses, inviting rheumatic diseases and catarrhal 
inflammations. 

Define the word " nuisance " in a broad hygienic sense. 

"Something which either actually injures, or is likely to 
injure health, and admits of a remedy either by the individual 
whose act or omission causes the nuisance, or by the local 
authority" (Winter-Blyth). 



HYGIENE. 397 

What injurious influences, if any, do cemeteries exert on 
the health of persons living in their vicinity? 

To most persons the mental effect is depressing. Water 
passing through the soil of cemeteries may contaminate the 
water supply of the neighborhood, with organic material and 
micro-organisms. The constant turning of soil of cemeteries 
may set free imprisoned gases from organic decomposition, 
and lead to contamination of the surrounding air. 

What gases and combination of gases are most efficient 
as disinfectants? 

Formaldehyde, sulphur dioxid, chlorin, ozone. 

What care should be employed in exhumations? 

The exhumation of those dead of contagious or infectious 
diseases should not be allowed. When possible, the exhum- 
ation should be deferred until cold weather. The presence 
of all persons except those absolutely needed should be for- 
bidden. As the workmen approach the coffin the earth should 
have poured upon it a strong watery solution of creolin. The 
coffins containing the remains should not be opened, but be 
placed at once in a zinc-lined box and hermetically sealed. 

What are the hygienic requirements and the physio- 
logical effects of bathing? 

The bath should be taken to obtain personal cleanliness, as 
well as for its stimulation of the peripheral circulation. 
Bathing should be postponed until at least two hours after 
a meal, and should consume only twenty minutes. Never 
bathe when very hungry, or when the body is overheated. 
Unless experience has shown that good effects accrue from 
a cold bath, secure a temperature of about 65 to 75 degrees 
Fahr. of the water. The bath should be followed by a 
thorough drying and brisk rubbing. Effects following a 
bath are removal of dirt and of dead epithelium from the 
person, stimulation of the functional activity of the skin; 
a general improvement in the circulation and increased func- 
tional activity of the organs of elimination. 



398 HYGIENE. 

How much fresh air is required for normal respiration 
during 24 hours? 

3000 cubic feet per hour, or 72,000 cubic feet of air in 
24 hours. 

How may a privy in city or country be kept while in 
use from becoming a nuisance? 

Have the privy emptied at frequent intervals. At inter- 
vals of five to seven days, pour into the privy vault milk of 
lime (about 20 grains of lime for each gallon of sewage), or 
strong solution of iron sulphate ; or at frequent intervals add 
clean, dry earth to the privy contents, and provide a ventilat- 
ing pipe extending high in the air and down into the privy 
vault. 

What explanation can be furnished for the greater pre= 
valence of diphtheria and small=pox in cold than in warm 
weather? 

During cold weather the houses are less perfectly venti- 
lated than in warm weather. Rooms are frequently over- 
heated, less attention is paid to personal cleanliness and 
there are more sudden changes in temperature. Such con- 
ditions lower the vitality of the body and predispose to 
disease. 

What are the principal adulterations of milk? 

Addition of water and abstraction of cream; addition of 
coloring water (annatto, caramel) ; preservatives (borax and 
boracic acid, salicylic acid, formaldehyde, chromates) ; gela- 
tine as a thickening for cream. 

What changes in food are effected by cooking? 

Parasites and germs are destroyed; the food is made more 
tender to facilitate mastication. The tough fibrous envelope 
of starch cells is softened, albumen is coagulated, the food 
is rendered more palatable, and the action of the different 
digestive fluids is aided. 



HYGIENE. 399 

State the advantage of cremation over earth burial. 

Complete destruction of specific disease germs. If crema- 
tion be well performed no obnoxious gases are given to the 
air, no gases of putrefaction contaminate the air, and there 
is no danger of contaminating the water supply through 
drainage from cemeteries. 

What are the respective merits of cotton, wool and silk 
when used as underwear? 

In a variable climate wool is preferable because from a 
larger amount of air enclosed in its texture it acts as a 
good non-conductor of heat, retaining the body heat. As 
wool is hygroscopic it readily absorbs moisture from which it 
parts slowly, so preventing surface chill of the individual by 
too rapid evaporation. Next in order to retain the heat of 
the body we rank silk and least valuable for the retention 
of body heat is cotton. If it be our purpose to supply a 
cool garment we would of course reverse this order of 
arrangement. 

What conditions of ill health make residence in high 
altitudes dangerous? Why? 

Chronic Bright 's Disease, disease of the heart, emphysema; 
and old age. High altitudes occasion increased respiratory 
effort from the rarified condition of the atmosphere, causing 
increased heart action, and a lessened perspiratory function. 

State the physical condition that makes the practice of 
taking hot baths inadvisable. 

Acute inflammatory diseases, tuberculosis, organic diseases 
of the heart and brain, aneurism, cancer, and all diseases in 
which stimulation of the circulation is to be avoided. 

State some of the sequelae of (a) over=strain, (b) over= 
exertion, (c) overstraining. 

(a) Parting of continuity of osseous, ligamentous, muscu- 
lar or bloodvessel structure leading to fractures, dislocations, 
rupture of muscles, hernia, rupture of heart muscles, disease 
of valves of heart and apoplexy. 



400 HYGIENE. 

(b) May produce same conditions as over-strain and in addi- 
tion cause general muscular relaxation, dyspnea, syncope, etc. 

(c) Loss of appetite and of muscular power, successive 
crops of boils appear, individual loses mental power, as of con- 
centration of thought, and digestive disturbances occur. 

What constitutes hard water and soft water? 

"Hardness is the capacity a water has for decomposing 
soap, and depends on the amount of salts of magnesia and 
calcium in solution." (Harrington.) 

Soft water contains little or no dissolved salts and rapidly 
forms a lather with soap. 

Mention the dangers of excessive shade about dwellings. 

Excessive shade interferes with the free movement of air, 
prevents penetration of the sun's rays, promotes dampness 
which is given off to the air by evaporation. It exerts a 
depressing mental action, promotes the growth of fungi and 
bacteria, and prevents the aspirating action of heat from the 
sun upon air and moisture in the soils. 

What is milk sterilization? How is it performed? 

Destruction of micro-organisms in the milk by heat. By 
continuous heating of the milk, under pressure, for two hours 
at 248° F. 

What infectious diseases may be due to impure drink- 
ing water? 

Typhoid fever, malarial fevers, cholera, relapsing fever, 
dysentery, parasitic diseases. 

Describe the physiological action of alcohol. 

Small or therapeutic doses increase the pulse rate and the 
arterial pressure by directly stimulating the heart. Over- 
doses directly depress and paralyze the heart muscle. Large 
doses produce decided lowering of body temperature. It is 
probable that the use of alcohol diminishes the elimination 
of C0 2 . Alcohol causes a great lessening in the excretion of 
the products of tissue waste. It is probable that alcohol in 



HYGIENE. 401 

not too large quantity is entirely destroyed in the body. In 
small doses alcohol acts as a cerebral stimulant, while larger 
doses greatly depress and abolish nervous activity, and check 
digestion. The habitual use of alcohol is accompanied by a 
disposition towards fatty degeneration, particularly of heart 
muscle, liver and kidneys, and an enlarged and dilated con- 
dition of the smaller bloodvessels and a degeneration of all 
nervous structures. 

Does alcohol possess a food action? On what do you 
base your answer? 

Yes. " In the sense that it is destroyed in the system and 
yields force utilized by the organism, and is, when in suffi- 
cient quantity, a retarder of tissue change, checking the ex- 
cretion of nitrogen " (H. C. Wood). "We see this in its 
administration in typhoid and other long continued fevers. 
Yet it is not a true food, since it also exerts toxic effects, 
which foods do not. 

The excavation of streets in cities is frequently fol = 
lowed by the outbreak of disease, such as diphtheria, 
typhoid fever. What is the cause? 

Pathogenic bacteria lie dormant in the soil of cities, and 
when such soil is exposed to the air, it becomes dried, and its 
contained bacteria taking on an active existence are liberated 
and carried by the air to susceptible individuals. 

How long does a diphtheritic patient remain infective? 
How may it be proved that this infective period has 
ceased? 

About three weeks after local symptoms cease. Make fre- 
quent cultures of material from the affected site, and when 
such fail to show the specific germ, the patient will no longer 
be a source of infection. 

How may milk be the means of transmitting the germs 
of typhoid fever? 

Through water containing Ebertlvs bacillus, gaining access 
26 



402 HYGIENE. 

to the milk, as through diluting the milk, washing milk 
receptacles in polluted water. 

Mention the effects of working in phosphorus, as in the 
manufacture of phosphorus matches. How can the dan= 
gers be limited or prevented? 

Inhaling phosphorus fumes produces a form of necrosis of 
the jaw, particularly in such as have imperfect teeth. To 
avoid its development persons of sound teeth and free from 
abrasion of the interior of the mouth should be employed. 
The work room should be large and well ventilated, with 
special air shaft to force the fumes away from the faces of 
workers ; the employes should have short working hours, and 
frequently use a mouth wash and gargle of lime water or 
carbonate of sodium. Turpentine and charcoal should be 
exposed in the room. 

What fruits are preferable in cases of habitual con= 
stipation? 

Apples, prunes, figs, grapes and melons. 

Describe the effect of a hot and moist climate on the 
human system and state the class of diseases this at= 
mosphere is likely to induce. 

In hot and moist climates the inhabitants, as a rule, are 
of small stature and deficient in muscular development; of 
languid disposition and nervous temperament. The diseases 
most prevalent are those affecting the liver and gastrointes- 
tinal tract ; also various forms of malarial disease, and yellow 
fever. 

What occupations are a menace to public health? Why? 

Those occupations that emit irritating, poisonous or noxi- 
ous fumes and gases from the vitiation of the atmosphere, 
as in fertilizing plants, chemical manufactories, bone-boiling 
establishments; also such occupations as give rise to much 
dust, especially if this be of sharp, hard character, as from 
cement making, in which the respiratory tract is subjected 
to irritation. 



, 



HYGIENE. 403 

Mention some of the objections to storage cisterns 
underground. What are the objections to rain water as 
a drink? 

They often receive dust and dirt ; sewer gas may gain en- 
trance to the water when the "standing waste" or overflow 
pipe of such cistern is connected with the drain or soil pipe 
of a house. Storage cisterns cannot be properly ventilated, 
and are often difficult to clean. 

If the first part of the rain be collected, such water will 
contain dust, pollen, gases and other matters washed from 
the air. 

Give an opinion as to the sanitary effect of the different 
methods of heating houses. 

The most desirable method is by Hot Water Heating by 
means of a complete plant with circulation of the hot water 
through radiators. Next in value to hot water heating is 
steam heating by radiators or by indirect radiation. The use 
of open fireplaces in the principal rooms is of great value in 
securing ventilation, but yields an unequal and insufficient 
supply of heat. Heating a house by hot air from basement 
heaters is efficient and gives good results, if the air supplied 
to the heater for distribution is pure and the house is not 
too large. 

Name eight principal carbohydrates used as food. 

Starch, glucose, saccharose, lactose, dextrin, cellulose, mal- 
tose and dextrose. 

Name the class of foods which should be given to chil= 
dren between the first and second years of age. 

We should supply foods in about the proportion of 2 parts 
proteid, 3 parts fat, 6 parts carbohydrates, the proteid food 
being preferably milk. 

What are some of the dangers involved in the domestic 
use of ice? 

Ice may contain pathogenic bacteria, and may, when re- 



404 HYGIENE. 

moved from a sick room transmit infectious disease to other 
members of the household. 

Define the term " quarantine," mention the principal 
quarantinable diseases, and give the rules for determin- 
ing the length of time each should be quarantined. 

"The adoption of restrictive measures to prevent the intro- 
duction of diseases from one country or locality into an- 
other. ' ' ( Wyman ) . 

Quarantinable diseases include cholera, small-pox, yellow 
fever, plague, scarlet fever, diphtheria, typhus fever, relaps- 
ing fever, cerebro-spinal meningitis, leprosy. 

In eruptive fevers isolation of the patient (quarantine) is 
continued for two weeks after the eruption has disappeared, 
except in the case of small-pox where quarantine lasts 30 days. 

The quarantine in diphtheritic cases does not cease until 
cultures made from the throat of the patient fail to show 
the bacillus of diphtheria. 

State the best means of disinfecting sputum. 

Sputum may be burned or received into vessels containing 
strong antiseptic solutions. 

What is understood by the germ theory of disease? 
Mention all diseases whose causes are known to be specific 
micro=organisms. 

The germ theory of disease contends that the exciting cause 
of each infectious or contagious disease is some specific 
organism, and that these diseases are communicated only by 
the transference to and development of the particular para- 
site or germ within or upon the tissues of the infected 
individual. 

Diseases due to specific micro-organisms are tuberculosis, 
diphtheria, cholera, typhoid fever, dysentery, pneumonia, 
glanders, leprosy, anthrax, erysipelas, gonorrhea, relapsing 
fever, malaria, plague and tetanus. 

Can it be proved that the diminished death rate from 



HYGIENE. ' 405 

diphtheria so generally announced is due to the use of 
diphtheria antitoxin? Give reasons. 

Yes. By comparing the death rate in hospitals treating 
the same class of patients, in the same community, during 
the same time, the one hospital using diphtheritic antitoxin, 
the other depending upon other methods of combatting the 
disease. Where the antitoxin is used, the death rate is much 
lower. 

Give the comparative nutritive value of sterilized or 
unsterilized cows' milk. 

The nutritive value of sterilized milk is less than of milk 
unsterilized. 

What evil consequences frequently result from the ex= 
cessive use of tobacco? 

Catarrhal inflammation of pharynx, tonsils and mouth. 
Nervous disorders of heart as palpitation, and insomnia also 
result. Derangements of stomach with loss of appetite, and 
impairment of vision together with paralysis of optic nerve, 
nervous tremors, and muscular twitchings may result. 

Mention five preventable diseases. 

Tuberculosis, typhoid fever, cholera, yellow fever and 
malaria. 

What is the best sanitary plan for the disposal of 

sewage? 

Collect the sewage in large tanks and to it add lime, alum 
or iron sulphate. Compress the solid materials after their 
subsidence or precipitation and cremate them. Allow the 
liquid sewage to flow upon specially prepared filter beds which 
are subdrained, the water flowing from these sub-soil pipes 
may then pass into a stream without great danger of adding 
poisonous materia] or pathogenic bacteria. 

What diseases are propagated by drinking water? 
How can their spread be prevented? 

Infectious diseases, particularly cholera and typhoid fever ; 



406 • HYGIENE. 

diseases due to gastric and intestinal irritation, as forms of 
dyspepsia, diarrhoea, dysentery; diseases due to animal para- 
sites; diseases due to metallic poisons. 

Prohibit the use of water containing any dissolved metal. 
Distil the water, or boil it for at least one half hour, thus 
purifying it. 

State the results to animal life of the combustion of 
fuel in a room without chimney connection or other 
ventilation. 

Carbon monoxid poisoning, suffocation due to excessive 
quantity of carbon dioxide and diminished amount of 
oxygen; a systemic poisoning due to breathing products 
which are the result of partial burning of excretions thrown 
off in exhalations. 

State the original source of all fresh water. 

The original source of fresh water is rain. 

State the impurities which rain water may contain. 
Describe the great value of rain water for domestic pur- 
poses and state the great objection to its general use. 

Rain water may contain microscopic growths, bacteria, 
ammonia, nitric and nitrous acid and other impurities from 
the collecting surface. 

On standing in the cistern many bacteria and other mi- 
croscopic growths may rapidly render it unfit for use. 

Rain water on account of its softness is of great value for 
cooking and washing purposes. The great objection to use 
generally is the limited and uncertain supply. 

In what part of an occupied room is the most impure 
air found? Give reasons. 

The lower part of an occupied room contains the most im- 
purities. The carbon dioxide is heavy and tends to accumu- 
late in the lower part of the room. The dust and other solid 
impurities are more abundant near the floor. 



HYGIENE. 407 

State the composition of atmospheric air. Is the mix* 
ture a chemical or mechanical one? 

Atmospheric air is made up of 20.96% of oxygen, .04% of 
carbon dioxide and 79% of nitrogen and other inert gases as 
argon and cry p ton. 

The mixture is a mechanical one. 

State the nervous disorders most common among school 
children. Mention some of the causes of these disorders. 

Among the many nervous disorders of school children are 
chorea, habit spasm, refractive errors of vision, deafness from 
catarrhal condition of nose, degeneracy, mental dullness and 
later in school life, neurasthenia. 

Among the causes of these are overcrowding, faulty light, 
lack of proper ventilation, improper desks, lack of personal 
hygiene, heredity, cramming and lack of proper food and 
exercise. 

State the average proportion of carbon dioxide in iooo 
parts of atmosphere. What should be the maximum limit 
of carbon dioxide in school rooms? 

Four parts of carbon dioxide to ten thousand of air is the 
normal. 

The maximum limit of carbon dioxide in a school room 
should be .05%. 

State the hygienic precautions that should be taken to 
prevent the spread of typhoid germs. 

The drinking water should be boiled, and the milk also if 
it is suspected of possibly being infected. 

The feces and all secretions, like urine and nasal mucus 
should either be destroyed by fire or properly disinfected with 
a strong solution of bichloride of mercury, chlorinated lime, 
formalin or carbolic acid. 

The clothing of the patient and the bed linen should be 
placed in strong bichloride solution, or preferably boiled 
for a half hour. 

The glasses and other dishes used by the patient should be 
boiled. 



408 HYGIENE. 

What instruction as to hygiene and sanitation should 
be given in a case of diphtheria? 

The case should be isolated, the house quarantined, and 
possibly those who have been exposed (especially children) 
had better be given a small dose of antidiphtheritic serum. 

The room should be well ventilated and as much sunshine 
as possible allowed to enter. 

The discharge from the mouth and nose should be de- 
stroyed by fire; the dishes should be boiled. 

The clothing and bed linen should be boiled or destroyed 
by fire. 

After the case has terminated the room should be thor- 
oughly disinfected with formalin or sulphurous acid, and the 
woodwork washed with 1 to 1000 bichloride of mercury 
solution. 

Name some of the impurities found in rain water that 
is stored in cisterns. 

Unicellular organisms of many kinds, decaying vegetation, 
nitrites, ammonia, nitric acid, and mechanical impurities. 

What are the general effects of breathing impure air? 

You get the symptoms of intoxication from the impurities 
of the air, such as headache, general malaise, loss of appetite, 
interference with mental activity, also interference with mus- 
cular activity, weak, low-tension pulse. 

State the composition of pure air; of expired air. 

Pure air consists of 20.9 parts of oxygen, .04 parts carbon 
dioxide and 79.+ nitrogen and other inert gases. Expired 
air consist of 15.9 parts of oxygen, 4.5 parts of carbon dioxide 
and 79. -f- nitrogen. 

If a chemical analysis of water revealed the presence 
of nitrites and nitrates, would this condemn it for drink= 
ing purposes, if so, why? 

Yes, particularly if nitrites be present. Organic matter, 
particularly sewage, is converted first into nitrites and these 



HYGIENE. 409 

into nitrates through the action of bacteria in the soil. These 
salts would, therefore indicate a former pollution of the 
water with probably some of that polluted material still in 
the water. 

If nitrates only are present and it can be shown that the 
organic matter is of a vegetable origin only, the water need 
not be condemned. 

On what generally accepted theory are toxins used for 
the prevention and cure of disease? 

That their presence in the system renders the blood no 
longer able to support the lives of bacteria that occasion 
such toxins. 

Under what condition is tyrotoxicon found in milk, 
cheese and other articles? 

Where milk, cheese, ice cream, etc., undergo decomposition 
in the presence of other organic matter, as rotting wood, 
mould, etc. 

Describe the agency of the ptomaines in inducing dis- 
eases and the disorders produced by them. 

Ptomaines are alkaloidal bodies resulting from decomposi- 
tion of nitrogenous substances. When absorbed into the 
blood they may give rise to fever, headache, torpor, fetid 
breath. They act like chemical poisons very soon after their 
introduction into the system. Many of them occasion dis- 
tinctive trains of symptoms. 

Mention an infectious disease which is often caused by 
drinking water and show how the germs of this disease 
are communicated to the water. 

Typhoid fever is frequently caused by drinking water. The 
excretions of the body are thrown on the ground or into im- 
properly made cesspools, and then drain into the drinking 
wells, or the excretions are thrown into a creek or river and 
carried down to a city that uses this river as a supply for 
drinking water. 



410 HYGIENE. 

State the number of cubic feet of oxygen absorbed in 
24 hours. 

There are 27 cubic inches of pure oxygen absorbed in one 
minute or 22y 2 cubic feet daily. 

Mention six kinds of food from which starch is derived. 

Starch is derived from potatoes, corn, rice, wheat, oats 
and sago. 

What is the lowest temperature of steam heat at which 
pus cocci are destroyed? 

At 240 deg. Fahr. such organisms are killed in a few 
minutes, while at 212 deg. Fahr. it requires an exposure to 
steam of from thirty to forty minutes. 

What is the temperature of tepid water, of hot water, 
of boiling water? 

Tepid water 75 to 85 deg. Fahr. 
Hot water 100 to 110 deg. Fahr. 
Boiling water 212 deg. Fahr. 

Differentiate between endemic and epidemic diseases. 

An endemic disease is one constantly present in a commun- 
ity. An epidemic disease is one which spreads rapidly, at- 
tacking many people at the same time. 

What is meant by natural and acquired immunity from 
disease? Give an example of each. 

By natural immunity we mean "that inherited trait from 
immune ancestors which enables an organism to resist the 
attacks of bacteria and their toxic secretions." Thus, as a 
rule the negro race do not contract yellow fever. By ac- 
quired immunity we understand that through a previous at- 
tack of an infectious disease, or by inoculation with an at- 
tenuated virus of that disease, the blood of the person under- 
goes such changes as to present a non-fertile soil to the or- 
ganism to whose presence the disease is due. Example, vac- 
cination in preventing small-pox. 



HYGIENE. 411 

Describe vitiation of the air from lack of ventilation. 

The vitiation of the air from lack of proper ventilation is 
caused by the using-up of the oxygen, the accumulation of 
carbon dioxide and other waste products thrown off by the 
respiratory tract and skin. 

What should be the lowest specific gravity of fresh 
milk? 

The lowest specific gravity of fresh milk should be 1029. 

In ioo parts of cow's milk, mention the per cent, of 
proteids, fats, sugar, salts and water. 

There is in cow's milk about 4% each of proteids, fats and 
sugar, about .7% of salts and the rest is water. 

State the advantages of a mixed diet. 

In a mixed diet one is more apt to get the right amounts 
of proteid, fats, carbohydrates and salts, the food is not too 
concentrated, nor does it contain too much waste, like cel- 
lulose. Proteids are absolutely necessary in the food. The 
vegetable foods are poor in proteid and the proteid is not as 
readily digested. Change of diet increases the appetite and 
this physical influence is the most powerful in causing a 
proper flow of the various digestive secretions. 

State a method of disinfecting a room that has been 
occupied by a diphtheritic patient. 

The bedding, unless it can be subjected to superheated 
steam, had better be burned. The room should be thor- 
oughly filled with abundance of formalin spray and kept 
closed for 24 hours. The room then should be thoroughly 
aired and exposed to the sunlight. The room should be re- 
papered and the woodwork and the floor washed with a 
1-1000 solution of mercuric chloride. 

How may the germs of infectious diseases be introduced 
into milk? 

The germs of infectious diseases may be introduced into 
milk bv washing the milk cans with infected water, bv water- 



412 HYGIENE. 

ing the milk with infected water, from the hands of those 
handling the milk, from infected cows (as tuberculosis) and 
by contact of infected air with the milk. 

State the objection to the use of wells within the 
city limits. 

The objection to these wells is, they are very likely to drain 
the nearby cesspools and the surface sewage, unless they 
are thoroughly made wells that pass through at least one 
layer of solid rock. 

Does regular physical exercise affect the condition of 
the mouth? If so, how? 

It affects the condition of the mouth by increasing the tone 
of the whole body, stimulating especially, the circulation 
and secretion. 

What is the best method of disinfecting instruments? 

The best method is moist heat. • 

State what hygienic measures a dentist should employ 
after operating at a chair. 

He should clean the nose, throat and mouth with an anti- 
septic solution; he should scrub the hands and place them 
in antiseptic solution for a few minutes. 

The instruments should be sterilized and the room aired if 
possible. 

What hygienic care should be given to an operating 
room? 

An operating room should be well ventilated without 
draughts, well lighted, scrupulously clean, well heated and 
should be rendered as nearly aseptic as possible after a 
septic operation. 



. ANATOMY. 



What is connective tissue? (b) Where is it found in 
the human body? 

The term connective tissue includes a number of tissues 
which serve the purpose of "connecting" and supporting dif- 
ferent tissues of the body. It is generally applied to tissue 
which fills in the interstices between organs, etc., and binds 
and supports them together. Most typically, it is found 
between muscles and surrounding blood-vessels. 

Give a general description of the nervous system. 

It consists of central and peripheral portions, the former 
made up largely of cells, and the latter of fibers. The brain 
and cord are contained in the cranial cavity and spinal canal. 
The brain, or encephalon, consists of cerebrum, cerebellum, 
pons and medulla; 12 pairs of nerves (cranial) pass out from 
these divisions through foramina in the cranial floor. The 
spinal cord has 31 pairs of spinal nerves attached to it. The 
cerebro-spinal axis is protected by 3 meninges, the dura" the 
arachnoid and the pia. 

The peripheral nervous system consists of nerves of special 
sense, of motion and of sensation; many of them are mixed 
nerves, as to function. In the cervical and lumbar regions, 
the spinal nerves unite to form the cervical, lumbar and sacral 
plexuses. 

The so-called sympathetic system, most intimately con- 
nected with the cerebro-spinal system, consists of collections 
of nerve cells known as ganglia, and of nerve fibers proceed- 
ing from these ganglia and uniting to form many plexuses, 
the largest of which are the three prevertebral, or the cardiac, 

(413) 



414 ANATOMY. 

solar and hypogastric plexuses. From these plexuses fibers 
proceed to supply viscera and blood-vessels. 

Describe the sphenoid bone. 

By reason of its location at the base of the skull, it arti- 
culates with all of the bones of the cranium and with five 
of the face. It forms the greater part of the middle cerebral 
fossae ; it consists of a body, two greater and two lesser wings, 
and a pair of pterygoid processes. The body is hollow and 
contains the sphenoidal cells, or sinuses; between the greater 
and lesser wings, on each side, is the sphenoidal fissure, which 
transmits the ophthalmic division of the 5th cranial nerve, 
the 3d, 4th and 6th cranials, and ophthalmic vein. On the 
upper surface of the body is the sella turcica, which re- 
ceives the pituitary body ; on either side of the body is the 
groove for the cavernous sinus; in the greater wing are the 
foramina rotundum, ovale and spinosum, . for the maxillary 
division of the 5th, the mandibular division of the 5th, 
and the middle meningeal artery, respectively. The greater 
wing forms, anteriorly, part of the wall of the orbit, and 
externally, part of the temporal fossa; the pterygoid process 
helps to form the pterygoid fossa, externally, and the outer 
wall of the posterior naris, internally. 

State the location, size and structure of the cerebellum. 

Is located in the cerebellar fossae of the occipital bone, 
beneath the tentorium cerebelli; it measures four (4) inches 
transversely, and is about two (2) inches thick; in structure 
it resembles the cerebrum to the extent that it has a cortex 
which is made up of cells (gray matter), surrounding a 
white center consisting of nerve fibers, and which also con- 
tains a special nucleus, the corpus dentatum. The cere- 
bellum is connected with the mid-brain (mesencephalon) by 
the superior peduncles, with the pons (epencephalon) by the 
middle peduncles, and with the medulla (metencephalon) by 
the inferior peduncles. 

Describe the trachea and give its anatomical relations. 

It extends from the larynx to the bronchi, and consists of 



ANATOMY. 415 

a series of transversely directed, incomplete rings of carti- 
lage united by an elastic membrane which contains involun- 
tary muscle-fiber posteriorly, where the cartilaginous ring 
is deficient; it is lined with a mucous membrane which is 
covered with ciliated columnar epithelial cells. 

The trachea rests upon the oesophagus, being flattened 
posteriorly; in the groove between these two structures is the 
recurrent laryngeal nerve, upon each side ; the common carotid 
artery, internal jugular vein and pneumogastric nerve are 
close to it at its lower portion, while the isthmus of the 
thyroid body crosses it upon its second and third rings, and 
the lobes of the same rest upon it laterally. 

Give the number and name the bones forming the skull. 

There are 22 bones in the skull : Cranium, 8 bones, viz., 
occipital, 2 parietal, frontal, 2 temporal, sphenoid, ethmoid. 
Face 14 bones, viz., 2 nasal, 2 superior maxillary, 2 lachrymal, 
2 malar, 2 palate, 2 inferior turbinated, vomer, inferior 
maxillary. 

Give the origin, insertion, action and nerve supply of 
the gastrocnemius muscle. 

Arises by 2 heads from the posterior surface of the condyles 
of the femur and adjacent part of the shaft; inserted by tendo 
Achillis into os calcis ; action, to extend foot upon leg ; nerve 
supply, internal popliteal. 

What structures pass through the foramen magnum? 

Spinal cord, meninges, spinal accessory nerves (2), verte- 
bral arteries (2), anterior and posterior spinal arteries. 

Name and give the origin and insertion of the muscles 
which depress the lower jaw. 

Genio-hyoid, from inferior genial tubercle of mandible be- 
hind symphysis into body of hyoid bone; mylo-hyoid, from 
mylo-hyoid ridge of mandible, into body of hyoid bone; an- 
terior belly of digastric, origin from inner surface of mandi- 
ble, near symphysis, into central tendon, attached to body of 
hyoid bone. 



416 ANATOMY. 

Give the blood supply of the tonsils. 

Ascending pharyngeal, tonsillar branch of dorsalis linguae, 
ascending palatine and tonsillar branches of facial, and de- 
scending palatine branch of internal maxillary. 

Mention the branches of the facial artery. 

Tonsillar, ascending palatine, muscular, glandular, sub- 
mental, inferior labial, inferior and superior coronary, lateral 
nasal, angular. 

Describe the mandible. 

The mandible, or inferior maxillary bone, consists of a 
horseshoe-shaped body which corresponds in shape with the 
alveolar border of the upper jaw, and extends upward and 
backward on either side as a ramus, which is surmounted by 
a coronoid process and a condyle, separated from each other 
by the sigmoid notch. The anterior extremity of the body 
projects as the mental protuberance (a characteristic of the 
human jaw), and the posterior end of the body, where it 
joins the ramus, is called the angle. Just anterior to this 
angle is a groove for the facial artery; the alveolar process, 
or border, contains sockets for the teeth, and is relatively 
thicker in the child's jaw, than in the adult's; behind the 
symphysis are the genial tubercles, while laterally from these 
are the depressions for the digastric muscles ■ more posteriorly 
still are the shallow fossae for the submaxillary glands ; upon 
the inner surface of the body, running downward and for- 
ward, is the mylo-hyoid ridge, for the mylo-hyoid muscle ; the 
ramus is roughened externally for the masseter, and inter- 
nally for the internal pterygoid muscle; upon the inner 
surface of the ramus is the inferior dental foramen, which 
leads into a canal of the same name ; to the coronoid process 
is attached the temporal muscle, while the condyle articu- 
lates with glenoid fossa of the temporal bone. 

Describe the hyoid bone. 

Is placed transversely above the thyroid cartilage, con- 
sisting of a centrally located body connected laterally with 



ANATOMY. 417 

two greater wings, and supporting, at the junction of the 
body and greater wing, on each side, the lesser wing. The 
hyoid bone supports the tongue and has twenty muscles at- 
tached to it. 

Describe the ethmoid bone. 

The ethmoid bone is a light spongy bone consisting of a 
central portion and two lateral masses. The central part 
presents a horizontal plate, perforated for the transmission 
of olfactory nerve filaments, hence called cribriform. Pro- 
jecting upward from the anterior median portion of the 
horizontal plate is the crista galli, serving for the attachment 
of the falx cerebri. From the under surface of the cribriform 
plate depends the perpendicular plate, which forms part of 
the nasal septum. The lateral mass, on each side, consists of 
two curling pieces of bone, the superior and middle turbinals, 
attached to the ethmoidal cells, which are limited exter- 
nally by a smooth plate called the os planum, which 
assists in the formation of the inner wall of the orbit. De- 
scending from the lateral mass is the unciform process which 
articulates with the inferior turbinated bone, and assists in 
forming part of the inner wall of the antrum of Highmore. 

Give origin, insertion and action of the buccinator 
muscle. 

Origin, from the alveolar processes of the superior and 
inferior maxillary bones, and behind, from the pterygo- 
maxillary ligament. Its superior fibres blend with the fibres 
of the orbicularis oris in the lower lip, its inferior fibres 
with the fibres of the orbicularis oris muscle in the upper 
lip. Its action is to assist in keeping the food between the 
teeth in mastication; it is used in such acts as whistling and 
in blowing a trumpet. 

What nerve supplies the muscles of expression? 

The facial, or seventh cranial nerve. 

What nerve supplies the muscles of mastication? 

Branches of the inferior maxillary division of the fifth 
cranial nerve. 
27 



418 ANATOMY. 

Mention the muscles attached to the occipital bone? 

Twelve pairs: Occipito-frontalis, sterno-mastoid, trapezius, 
spienius capitis et colli, complexus, obliquus capitis superior, 
rectus capitis anticus major and minor, rectus capitis posticus 
major and minor, rectus capitis lateralis and superior con- 
strictor of pharynx. 

Give the course and relations of the external jugular 
vein. 

It begins in the lower part of the parotid gland, on a level 
with the angle of the mandible, and courses downward from 
the angle of the jaw to the middle of the clavicle; it crosses 
the sterno-mastoid muscle, lies beneath the platysma myoides, 
and terminates in the subclavian vein. 

Name the three classes of articulations. 

Synarthrosis, amphiarthrosis and diarthrosis. 
What nerves pass through the sphenoidal fissure? 

The third, fourth, ophthalmic division of the fifth, and the 
sixth cranial nerves. 

Give the origin, insertion, nerve supply, and action of 
the pterygoid muscles. 

The external pterygoid muscle arises by two heads. The 
upper head arises from the inferior surface of the great wing 
of the sphenoid below the pterygoid ridge, the lower from 
the outer surface of the external pterygoid plate. Its fibers 
pass horizontally backward and outward to be inserted into 
the depression in front of the neck of the condyle of the 
lower jaw, and into the interarticular fibro-cartilage. 

Internal pterygoid muscle arises from the pterygoid fossa 
and is inserted into the inner surface of the ramus and angle 
of the lower jaw. 

Nerve supply, mandibular division 5th cranial. Action, 
both external pterygoids throw lower jaw forward, while 
each, acting alternately, produces triturating movement; in- 
ternal pterygoids bring lower jaw up against upper jaw, and 
assist external pterygoids in carrying jaw forward. 



ANATOMY. 419 

Mention the arteries from which the superior maxillary 
bone derives its blood supply. 

Alveolar, anterior and middle dental, branches of infra- 
orbital, and spheno-palatine and posterior palatine, branches 
of internal maxillary. 

Describe the salivary glands. Where do these glands 
empty? 

Parotid, submaxillary, sublingual. Parotid, largest, placed 
in front of ear, behind ramus of mandible; duct (Steno's) 
passes across masseter muscle, perforates buccinator muscle, 
terminates in cheek wall opposite upper middle molar. 
Parotid gland has facial nerve, external carotid artery, 
temporo-maxillary vein passing through it. 

Submaxillary gland is located upon inner side of body of 
mandible posteriorly, and is crossed by facial artery; duct 
(Wharton's) passes forward, terminating close to fraenum 
linguae. 

Sublingual gland, located in shallow fossa upon inner side 
of body of mandible, near s}^mphysis, is covered by mucous 
membrane of mouth; ducts (of Rivinus and Bartholin) 
terminate near fraenum linguae. 

What bones enter into the formation of the orbital 
cavities? 

Frontal, sphenoid, ethmoid (3 singles) ; lachrymal, su- 
perior maxillae, malar, palate (4 pairs). 

Describe the frontal bone and give its articulations. 

The vertical portion forms the forehead, is convex ex- 
ternally, presents two slightly raised eminences, the frontal, 
one to either side of the median line, while below them are 
the superciliary ridges, and below the latter, the supra-orbital 
arches, which terminate externally and internally in the ex- 
ternal and internal angular processes, respectively. Each 
supra-orbital arch presents the supra-orbital notch, or fora- 
men, at the junction of its inner and middle thirds. Between 
and below the two superciliary ridges is the glabella; the 



420 ANATOMY. 

lateral segment of the vertical portion forms part of the tem- 
poral fossa, and the temporal ridge has its beginning in the 
external angular process, curving upward and backward. 
Upon the inner surface of the vertical portion are irregulari- 
ties corresponding to cerebral convolutions; longitudinally 
placed is the groove for the superior longitudinal sinus. 

The horizontal portion is composed of the two thin orbital 
plates, separated from each other by the ethmoidal notch, 
which is filled in by the ethmoid bone ; these plates are smooth 
and concave underneath, but irregularly convex above. 

Frontal bone articulates with both parietals, both malars, 
both nasals, both lachrymals, both maxillae, and with the 
ethmoid and sphenoid. 

Describe the temporal bone. 

Is made up of 3 divisions, squamous, mastoid and petrous. 

Squamous bone has vertically placed scale-like plate which 
forms large part of temporal fossa externally and of middle 
cerebral fossa internally; zygomatic process curves forward 
from it, while beneath is the glenoid fossa for condyle of man- 
dible, located just behind eminentia articularis, and in front 
of tympanic plate (anterior wall of tympanum and external 
auditory canal). 

Mastoid bone is placed behind, is rough and convex ex- 
ternally and projects downward and forward as mastoid pro- 
cess; beneath are digastric fossa for posterior belly of digas- 
tric muscle, and occipital groove for occipital artery; within 
substance of mastoid are mastoid cells, the largest of which 
is called mastoid antrum, which communicates with middle 
ear; upon cerebral surface of mastoid is sigmoid groove for 
lateral sinus. 

Petrous bone is pyramidal and is wedged in between squa- 
mous and mastoid bones; base presents oval opening, the 
external auditory meatus, to rough edge of which (auditory 
process) auricle is attached; apex, directed forward and in- 
ward, is notched to help form middle lacerated foramen, for 
entrance of internal carotid artery into cranial cavity ; cranial 



ANATOMY. 421 

aspect of petrous bone forms ridge for attachment of dura 
(tentorium), a depression near apex for Gasserian ganglion, 
and upon posterior surface, the internal auditory meatus, 
for auditory and facial nerves ; petrous bone forms bony part 
of external auditory canal, the middle ear, and contains the 
osseous labyrinth; upon its under surface are to be found, 
near the center, the beginning of the carotid canal, behind 
and to the outer side of which is the jugular fossa, which, 
with a notch on the occipital bone, completes the jugular 
foramen ; the styloid process, surrounded by the vaginal pro- 
cess at its base, may be seen projecting downward, forward 
and inward; the stylo-mastoid foramen, giving entrance to 
the stylo-mastoid artery and exit to the facial nerve, is to be 
found between the styloid and mastoid processes. 

Temporal bone articulates with 5 bones : occipital, parietal, 
sphenoid, malar and mandible. 

Describe the ophthalmic artery. 

Is a branch of internal carotid, given off just after carotid 
has left cavernous sinus; it enters orbit by passing through 
the optic foramen, courses toward internal angular process 
where it divides into frontal and nasal. Branches are lachry- 
mal, ciliary, arteria centralis retinae, muscular, anterior and 
posterior ethmoidal, palpebral and supra-orbital. 

Describe the pulmonary veins. 

They are four in number, usually, 2 for each lung, and 
return arterial blood from lungs to left auricle of heart. 

Describe the otic ganglion. 

Is a small, flattened ganglion situated immediately beneath 
foramen ovale ; it receives motor and sensory roots from 
mandibular division of the 5th cranial; the small superficial 
petrosal nerve also enters it, furnishing branches of com- 
munication from the glosso-pharyngeal (sensory) and facial 
(motor) ; the sympathetic fibers come from the middle menin- 
geal plexus. Its branches of distribution are to the tensor 
tympani and tensor palati muscles, and to the chorda tym- 
pani nerve. 



422 ANATOMY. 

Give a brief description of the facial nerve. 

The 7th cranial nerve, after passing through facial canal 
(aquaeductus Fallopii) of temporal bone, emerges at the 
stylo-mastoid foramen, and enters substance of parotid gland. 
Here it divides into 2 sets of branches, temporo-facial and 
cervico-facial, supplying muscles of expression. Its chorda 
tympani branch traverses inner surface of membrana tym- 
pani, after leaving main trunk in facial canal, and emerging 
through one end of the Glaserian fissure unites with lingual 
branch of 5th and accompanies it to submaxillary gland and 
ganglion and anterior % of mucous membrane of tongue. 

Describe the hypoglossal nerve. 

The 12th cranial nerve leaves cranial cavity by anterior 
condyloid foramen and descends almost vertically to a point 
corresponding with angle of jaw; it loops around occipital 
artery, then lies above hyoid bone, supplying intrinsic muscles 
of tougue. A communication from 1st and 2d cervical nerves 
after uniting with hypoglossal, leaves it to form descendens 
hypoglossi, branches from which are distributed to extrinsic 
muscles of tongue and depressors of hyoid bone. 

Describe the nasal bone and give its articulations. 

It forms "the bridge" of the nose, is oblong in shape, con- 
cave longitudinally, convex transversely: is grooved pos- 
teriorly for branch of nasal nerve ; upper margin is thick and 
serrated, while lower is thin, and notched ; upper margin arti- 
culates with frontal bone, while lower has lateral cartilage of 
nose attached to it. It articulates with frontal, ethmoid, 
maxilla and opposite nasal. 

Mention the muscles attached to the temporal bone. 

Fifteen, viz. : temporal, masseter, occipito-f rontalis, sterno- 
mastoid, splenius capitis, trachelo-mastoid, digastric, re- 
trahens aurem, stylo- pharyngeus, stylo-hyoid, stylo- glossus, 
levator palati, tensor tympani, tensor palati, and stapedius. 



ANATOMY. 423 

Give origin and insertion of each of the muscles of the 
palpebral region. 

Three : orbicularis palpebrarum, corrugator supereilii and 
levator palpebrae. Orbicularis palpebrarum : origin, internal 
angular process of the frontal bone, and nasal process of the 
superior maxilla ; passes outward around the circumference 
of the orbit and is inserted, some fibres into the tarsal liga- 
ments, others forming a complete ellipse; the remaining 
fibres blend with the surrounding muscles. 

Corrugator supereilii : origin, from the inner extremity of 
the superciliary ridge, passing out to be inserted into the 
skin. 

Levator palpebrae : origin, the under surface of lesser wing 
of sphenoid above and in front of optic foramen. It passes 
outward along the roof of the orbit, becomes aponeurotic, 
and is inserted into the upper margin of the superior tarsal 
plate. 

Describe the superior longitudinal sinus. 

It extends from the crista galli of ethmoid to internal occi- 
pital protuberance of occipital; it increases in size as it is 
traced backward, draining the cortex of the cerebral hemi- 
spheres of venous blood. It usually becomes continuous 
with right lateral sinus. 

Describe the subclavian vein. 

A continuation of the axillary, it extends from outer bor- 
der of 1st rib to near sterno-clavicular joint, where it unites 
with internal jugular to form innominate vein (brachio- 
cephalic). It is anterior to subclavian artery, on 1st rib 
separated from the artery by anterior scalene muscle. Its 
tributaries are external and anterior jugular veins; the left, 
at its point of junction with the internal jugular, receives 
the thoracic duct. 

Describe the submaxillary ganglion. 

Small in size, is situated upon deep portion of submaxillary 
salivary gland; is connected with lingual (gustatory) nerve, 



424 ANATOMY. 

and receives a branch from chorda tympani of facial; it com- 
municates with sympathetic plexus around facial artery. 
Branches of distribution are to mucous membrane of mouth 
and Wharton's duct. 

Describe the ophthalmic nerve. 

1st division of 5th, is entirely sensory. It arises from 
Gasserian ganglion, and before passing through sphenoidal 
fissure into orbit, divides into 3 branches, viz., lachrymal, 
frontal, nasal. 

Lachrymal supplies lachrymal gland, conjunctiva and up- 
per eyelid. 

Frontal, largest branch, divides into supratrochlear and 
supra-orbital, supplying skin of upper eyelid and of fore- 
head, and integument and pericranium over half of head as 
far as occiput. 

Nasal branch leaves orbit by anterior ethmoidal foramen, 
enters nose and supplies mucous membrane of nose and 
integument covering ala. 

Name the arteries and nerves of the gums. 

Arteries are branches of internal maxillary, anastomosing 
with branches of facial artery through cheek wall. Nerves 
are from maxillary and mandibular divisions of 5th cranial, 
and branches from Meckel's ganglion. 

What bones encase the brain and what is their relative 
position? 

Occipital, both parietals, frontal, both temporals, sphenoid 
and ethmoid. Occipital is behind and below, parietals are 
above and at the sides, frontal is anterior, temporals are be- 
neath and at the sides, sphenoid and ethmoid are beneath, 
anteriorly. 

Describe the spinal column. 

It consists of 33 separate vertebrae, distributed as follows: 
7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal. Sacral 
and coccygeal coalesce early in life by ossification of inter- 
vertebral substances ; cervical segment possesses curve with 



ANATOMY. 425 

convexity forward, thoracic with convexity backward, lumbar 
with convexity forward, sacral with convexity backward ; 
line of gravity passes through chords of these curves. 
Special, or peculiar, vertebrae are: atlas, axis, 7th cervical 
(vertebra prominens) ; ribs articulate with thoracic series; 
ilia articulate with sacrum. Spinal column contains neural 
canal for spinal cord. 

What are tendons and their function? 

They are rounded (cord-like) or narrow (ribbon-like) 
bundles of white fibrous tissue attaching muscles to bones or 
forming ligaments of joints, (shoulder, hip). 

Describe the elbow=joint and the manner of its lubri= 
cation. 

Is a ginglymus, or hinge- joint, made up of lower end of 
humerus and upper ends of radius and ulna : head of radius 
articulates with capitellum, and greater sigmoid cavity of 
ulna with trochlear surface of humerus. Its capsule is 
divided into anterior and posterior, internal and external 
lateral ligaments. It permits of flexion and extension. It is 
lubricated by synovial membrane lining its capsule. 

Describe the knee=joint and its manner of lubrication. 

Trochlear surface of condyles of femur, upper surfaces of 
tuberosities of tibia, and posterior surface of patella form its 
bony parts. These are completely surrounded by a capsule 
which is strengthened antero-laterally by aponeurotic inser- 
tions of vastus externus and internus and by fascia lata ; 
externally by a special band, or thickening, the external 
lateral ligament, and internally by the internal lateral liga- 
ment; posteriorly by the reflected tendon of the semimem- 
branosus muscle. 

Internal ligaments are anterior and posterior crucial, be- 
tween intercondyloid notch of femur and non-articular sur- 
face around spine of tibia; also 2 semilunar fibro-cartilages. 
attached to spine of tibia, while the internal is also attached 
to internal lateral ligament. 



±26 ANATOMY. 

Synovial membrane is large, lines capsule and is reflected 
into interior of joint around crucial ligaments, its folds here 
containing fatty tissue ; it is extended upward beneath quad- 
riceps tendon. 

What muscles are involved in respiration? 

Diaphragm, external and internal oblique, transversalis 
and rectus, of abdominal walls, external and internal inter- 
costals, serratus posticus superior and inferior. 

Give the muscles of facial expression. 

Occipito-frontalis, corrugator supercilii. orbicularis palpe- 
brarum, levator labii superioris alaeque nasi, levator labii 
superioris, levator anguli oris, zygomaticus major and minor 
orbicularis oris, depressor anguli oris, depressor labii inferioris 
and platysma myoides. 

Describe the joint in which the mandible works and 
the tissues constituting the joint. 

Bony parts are glenoid fossa and articulating eminence of 
temporal bone, and condyle of mandible; ligaments form a 
capsule, much stronger externally and posteriorly; external 
lateral ligament extends between tubercle of zygoma and neck 
of condyle; associated ligamentous bands are spheno-mandi- 
bular and stylo-mandibular ; an interarticular cartilage con- 
tained within the joint cavity has tendon of insertion of ex- 
ternal pterygoid muscle attached to it. Movements per- 
mitted are depression and elevation of jaw around a trans- 
verse axis, and a sliding forward of both sides, protruding 
chin, or of one side at a time, producing a triturating 
movement. 

Name the bones of the head and face and give the articu- 
lations of the maxilla. 

Cranium : occipital, 2 parietal, frontal, 2 temporal, sphe- 
noid, ethmoid. Face: 2 Lachrymal. 2 malar, 2 nasal. 2 
maxillae, 2 palate, 2 inferior turbinated, vomer, mandible. 

Maxilla articulates with 9 bones : Frontal, ethmoid, nasal, 



ANATOMY. 427 

lachrymal, malar, palate, inferior turbinated, vomer and op- 
posite maxilla. 

Describe the shou!der=joint. 

Variety, enarthrodial' (ball-and-socket) ; bones, glenoid 
fossa of scapula, head of humerus ; ligament, capsular, which 
is intimately blended with tendons of insertion of sub- 
scapularis, supraspinatus, infraspinatus and teres minor 
muscles ; tendon of long head of biceps passes within capsule 
over humeral head, and is surrounded by synovial mem- 
brane ; movements, flexion, extension, abduction, adduction, 
rotation and circumduction. 

Describe the superior maxillary bone. 

Consists of body and nasal, alveolar, palatal, and malar 
processes. 

Body is irregularly cuboidal, contains cavity called maxil- 
lary sinus (antrum of Highmore), which is lined with 
mucous membrane in recent state ; its external surface pres- 
ents eminences corresponding to roots of teeth, also incisive 
fossa, near median line, and canine fossa, to outer side of 
canine eminence ; above canine fossa is infra-orbital foramen, 
the termination of infra-orbital canal which traverses orbital 
surface ; posterior, or zygomatic, surface is convex and forms 
part of zygomatic fossa ; it presents orifices of posterior dental 
canals, for dental vessels and nerves ; internal surface is ir- 
regular, contains turbinated crest for articulation of inferior 
turbinated bone, groove for naso-lachrymal duct and helps to 
form outer wall of nasal meati. 

Maxillary sinus (antrum of Highmore) is large, pyramidal, 
has thin walls, opens into middle meatus of nose by aperture 
which is narrowed by articulating with ethmoid above, in- 
ferior turbinated below and palate bone behind. 

Nasal process projects upward, forming lateral wall of 
nose, articulating with nasal, frontal and lachrymal bones; 
alveolar process is thick, spongy and contains alveoli (8 in 
number) for teeth; malar process is thick, rough and ser- 
rated for articulation with malar bone ; palate process is di- 



428 ANATOMY. 

rected horizontally inward and articulates with fellow of 
opposite bone and with palate bone behind; its superior sur- 
face is smooth and slightly concave from side to side, form- 
ing floor of nasal chamber, and rough beneath, where it con- 
stitutes roof of mouth; at anterior end of it is to be found 
anterior palatine canal, situated in median line. 

Give origin, insertion, action and nerve supply of the 
omo=hyoid muscle. 

Origin from superior border of scapula and occasionally 
from suprascapular ligament; insertion into body of hyoid 
bone; beneath sterno-mastoid it develops a central tendon 
which is held down to 1st rib and clavicle by a process of 
deep cervical fascia; action, to depress hyoid bone and to 
support soft parts of neck during prolonged or difficult in- 
spiratory efforts by making tense the cervical fascia; nerve 
supply, cervical nerves through descendens and communi- 
cans hypoglossi. 

Give the origin, insertion, action and nerve supply of 
the genio=hyo=glossus muscle. 

Origin, superior genial tubercle of mandible ; insertion, into 
deep part of tongue close to median septum, or raphe, from 
tip to base, and into body of hyoid bone ; action, to protrude 
base and retract tip, and to make tongue concave trans- 
versely; nerve, hypoglossal. 

Describe the superior thyroid artery. 

Branch of external carotid formed just above thyroid carti- 
lage, curves inward and downward, giving off hyoid, mus- 
cular, superior laryngeal, crico-thyroid and glandular branches 
to interior and exterior of larynx and to thyroid gland. 

Describe the mylo=hyoid nerve. 

Is a branch of inferior dental nerve given off just as the 
latter is about to enter inferior dental canal ; mylo-hyoid nerve 
passes forward and downward in groove on inner surface of 
body of mandible, and supplies mylo-hyoid and anterior belly 
of digastric muscles. 



ANATOMY. 429 

Describe the os planum. 

Is a smooth, horizontally oblong plate of bone forming 
outer boundary of lateral mass of ethmoid and part of inner 
wall of orbit; it articulates with frontal above, lachrymal 
anteriorly, maxilla below and with sphenoid and palate bone 
posteriorly. 

Mention the number of points of ossification of the in- 
ferior maxillary bone, and describe its development. 

Five centers of ossification. 

Is developed chiefly in membrane, but partly from cartilage, 
ossification commencing earlier than in any other bone except 
clavicle. Most of the bone is formed from center of ossifica- 
tion which appears between 5th and 6th week in membrane on 
outer surface of Meckel 's cartilage ; 2d center appears on in- 
ner surface of Meckel's cartilage and develops into inner 
wall of teeth sockets ; anterior extremity of Meckel 's cartilage 
ossifies and forms body of jaw ; separate centers appear in con- 
dyle, coronoid process and angle. At birth mandible con- 
sists of 2 halves united by a fibrous symphysis, which ossi- 
fies during 1st year. 

Give origin, insertion, action and nerve supply of di» 
gastric muscle. 

Origin, posterior belly from digastric groove on under sur- 
face of mastoid portion of temporal, anterior belly from inner 
surface of mandible near symphysis; posterior belly extends 
downward and forward, anterior belly extends downward and 
backward, both to be inserted into a central tendon which 
perforates tendon of insertion of stylo-hyoid and is held to 
hyoid bone by fibrous loop. Action, raises tongue, in deg- 
lutition, and when hyoid bone is fixed by its depressors the 
digastric will depress lower jaw. Nerve supply: anterior 
belly by mylo-hyoid branch of inferior dental, posterior belly 
by facial nerve. 

Mention the muscles of mastication and give their origin 
and insertion. 

Temporal: origin, from temporal fossa between temporal 



430 ANATOMY. 

ridge above and pterygoid ridge below, and from external 
angular process of frontal to mastoid process of temporal, 
also from inner surface of temporal fascia ; into coronoid pro- 
cess of mandible. 

External pterygoid : origin, by two heads, upper from under 
surface of great wing of sphenoid, lower from outer surface 
of external pterygoid plate; insertion into neck of condyle 
of mandible and interarticular fibro-cartilage of temporo-man- 
dibular joint. 

Internal pterygoid : origin, from pterygoid fossa ; inser- 
tion into inner surface of angle and ramus of mandible as 
high as dental foramen. 

Masseter: origin, from malar process of maxilla and lower 
border and inner surface of zygomatic arch; insertion into 
external surface of ramus of mandible. 

Mention the muscles attached to the hyoid bone. 

Genio-hyo-glossus, genio-hyoid, mylo-hyoid, stylo-hyoid, 
aponeurosis of digastric, hyo-glossus, middle constrictor of 
pharynx, sterno-hyoid, thyro-hyoid, omo-hyoid. 

Describe the aorta. 

Springs from left ventricle, anteriorly, extends upward 
to upper border of right 2d costal cartilage, then arches 
backward to left and descends through thorax, resting upon 
vertebral bodies, passes through aortic opening in diaphragm 
and courses through abdominal cavity as far as body of 4th 
lumbar vertebra. 

Branches are 2 coronary from ascending portion ; innomin- 
ate, left common carotid and left subclavian from arch ; bron- 
chial, intercostal, pericardiac, esophageal and posterior medi- 
astinal from thoracic portion ; 2 phrenic, lumbar, sacra media 
(parietal branches), coeliac axis (gastric, hepatic, splenic), 
superior mesenteric, inferior mesenteric (single branches from 
front), suprarenal, renal, spermatic (or ovarian) (lateral 
paired branches) from abdominal portion. 

Describe the superior vena cava. 

Is formed by union of right and left innominate (jugulo- 



ANATOMY. 431 

cephaHc) ceins, just below cartilage of 1st rib (close to 
right border of sternum; is nearly 3 inches long and ter- 
minates in right auricle; it receives vena azygos major. 

Describe the fissure of Rolando. 

It is boundary line between frontal and parietal lobes of 
brain, extending from point at or near great longitudinal 
fissure just behind midpoint between anterior and posterior 
poles of cerebrum, downward and forward at angle of 67° 
with the sagittal axis, for a distance of 3% inches. Ascend- 
ing frontal convolution forms its anterior wall, and ascend- 
ing parietal convolution its posterior wall. 

Describe the inferior maxillary nerve. 

Motor root of 5th cranial unites with 3d branch of 
Gasserian ganglion to pass through foramen ovale, then to 
divide into an anterior and a posterior trunk • anterior, smaller 
and mostly motor, is distributed to muscles of mastication; 
posterior, mostly sensory, divides into auriculotemporal, 
lingual and inferior dental. 

Mention the muscles attached to the sphenoid bone. 

Temporal, external pterygoid, internal pterygoid, superior 
constrictor, tensor palati, levator palpebrae superioris, su- 
perior, inferior, internal and external recti, and superior 
oblique. 

Describe the Vidian nerve. 

Begins in cartilage filling up middle lacerated foramen 
by union of large superficial petrosal (branch of facial) with 
large deep petrosal (from carotid plexus), passes forward 
through Vidian canal to enter spheno-maxillary fossa, here 
joining Meckel's ganglion. 

Mention the branches of the occipital artery. 

Muscular, sterno-mastoid, auricular, meningeal and arteria 
princeps cervicis. 

Describe the palato=glossus muscle. Give origin, in- 
sertion and nerve supply. 

Origin, anterior surface of soft palate close to uvula; in- 



432 ANATOMY. 

sertion, into side and substance of tongue; action, to con- 
strict fauces and retract tongue; nerve supply, branch of 
spinal accessory. 

Describe the internal jugular vein. 

Is formed just below jugular foramen by lateral and in- 
ferior petrosal sinuses; courses down neck beneath anterior 
border of sterno-mastoid muscle in a common sheath with in- 
ternal carotid (above), common carotid (below), and pneu- 
mogastric nerve, the latter behind and between, and the 
artery to the inner side of the vein, which partially overlaps 
the artery. Behind sternal end of clavicle it unites with sub- 
clavian to form innominate vein. Its tributaries are facial, 
lingual, pharyngeal, superior and middle thyroid veins and 
sometimes the occipital vein. 

What muscles control the soft palate? 

Tensor palati and levator palati, azygos uvulae, palato- 
glossus and palato-pharyngeus. 

What are the terminal branches of the external carotid 
artery? 

Superficial temporal and internal maxillary. 

Describe the maxillary sinus (or antrum of Highmore). 

Is a triangular cavity contained in body of maxilla, lined 
with mucous membrane and communicating with middle 
meatus of nose through one or two small openings; apex of 
cavity is formed by malar process of maxilla; base is formed 
by outer wall of nose; in its posterior wall are posterior 
dental canals for posterior dental vessels and nerves to the 
teeth ; in floor are usually seen several elevations, correspond- 
ing to roots of 1st and 2d molar teeth. 

What forms the circle of Willis? 

The 2 internal carotids, 2 anterior cerebrals connected by 
anterior communicating, 2 posterior communicating and 2 
posterior cerebrals. 



ANATOMY. 433 

Describe the gustatory (lingual) nerve. 

Is a branch of posterior trunk of mandibular division of 
5th cranial, lying deeply placed beneath external pterygoid 
muscle where it is joined by chorda tympani nerve from 
facial; it takes a deep course until it gets beneath mucous 
membrane of floor of mouth, where it is distributed to 
papillae and mucous membrane of anterior % of tongue. 

What are the articulations of the malar bone? 

With 4 bones : frontal, sphenoid, temporal and maxilla. 
Name articulations of the occipital bone. 

With 6 bones: two temporal, two parietal, sphenoid and 
atlas. 

Describe the inferior dental artery and name its 
branches. 

Is a branch of the 1st division of the internal maxillary 
artery, passing into inferior dental canal at dental foramen, 
accompanied by inferior dental nerve, coursing along inferior 
dental canal to mental foramen, opposite 1st bicuspid tooth, 
where it divides into an incisor and a mental branch. The 
former remains within the jaw to supply the anterior teeth, 
anastomosing at symphysis with the incisor branch of the 
opposite side, while the latter escapes at the mental foramen 
to supply chin structures. 

Branches are : lingual, accompanying lingual nerve to 
mucous membrane of floor of mouth ; mylo-hyoid, accompany- 
ing mylo-hyoid nerve to mylo-hyoid muscle; branches which 
enter pulp cavities at apices of roots; terminal branches, 
incisor and mental. 

What artery supplies the tongue with blood? 

Lingual. (The principal one). 

Name the articulations of the temporal bone. 

Occipital, parietal, sphenoid, malar and mandible. 
28 



434 ANATOMY. 

Name the muscles of the tongue and their attachments. 

Intrinsic: divisions of lingualis. Extrinsic: genio-hyo- 
glossus, hyo-glossus, stylo-glossus, palato-glossus. 

Lingualis consists of superior lingualis (longitudinal fibers), 
transverse lingualis, inferior lingualis and vertical lingualis. 
These bundles and strata of muscular fibers intersect each 
other, being attached to under surface of mucous membrane 
and to raphe. 

Genio-hyo-glossus, origin superior genial tubercle; inser- 
tion deep surface of tongue and body of hyoid bone. Hyo- 
glossus, origin body, greater and lesser eornua of hyoid; in- 
sertion side of tongue. Stylo-glossus, origin styloid process; 
insertion side of tongue. Palato-glossus, origin anterior sur- 
face of soft palate ; insertion side of tongue. 

Describe the lingual artery and give its branches. 

Is a branch of external carotid, formed near greater cornu 
of hyoid bone, runs in curved manner forward to beneath 
hyo-glossus muscle, then in tortuous course to tip of tongue 
under name of ranine artery. Branches are, hyoid, dorsalis 
linguae, sublingual, ranine. 

Describe the occipito=frontalis. 

Arises from outer % of superior curved line of occipital 
bone and from mastoid bone as posterior belly which blends 
with centrally placed aponeurosis on vertex, which is con- 
tinued forward into anterior belly, the latter being united 
to the orbicularis palpebrarum, corrugator supercilii and 
pyramidalis nasi. Action, to raise brows, produce transverse 
wrinkles of forehead and move scalp backward and forward. 

What muscles control the eye? 

Superior, inferior, internal and external recti ; superior and 
inferior oblique. 

Which artery is the longer, the external or the in- 
ternal carotid? 

Internal carotid. 



ANATOMY. 435 

Mention the muscles of the pharynx. 

Superior, middle and inferior constrictors (2 each), palato- 
pharyngeus and stylo-pharyngeus. 

Describe (a) facial vein, (b) the internal maxillary vein. 

Facial vein begins by an anastomosis with angular vein 
near inner canthus, passes downward and outward diagonally 
across face, turns over body of mandible in front of masseter 
muscle and unites with branch from temporo-maxillary vein 
to form common facial, this, in turn, emptying into internal 
jugular. 

Internal maxillary vein accompanies artery of the same 
name, receiving tributaries which correspond to branches of 
the artery, and communicating freely with facial vein and 
cavernous sinus (through foramen ovale and middle lacer- 
ated foramen) . Internal maxillary vein then unites with tem- 
poral vein, forming temporo-maxillary vein. 

Give the branches of the external carotid artery. 

Ascending pharyngeal, superior thyroid, lingual, facial, 
posterior auricular, occipital, temporal and internal maxillary. 

What muscles have their origin from the styloid process? 

Stylo-glossus, stylo-hyoid, stylo-pharyngeus. 

Give the origin and insertion of the sterno=mastoid 
muscle. 

Origin, by 2 heads, one from inner third of superior border 
of clavicle, the other from front of manubrium sterni; in- 
sertion into mastoid process and outer y 2 of superior curved 
line of occipital bone. 

Describe the tensor palati. 

Origin from scaphoid fossa of sphenoid and margin of 
Eustachian tube, extends downward, has tendon which hooks 
round hamular process of internal pterygoid plate, then to 
be inserted into aponeurosis of soft palate and into hori- 
zontal portion of palate bone. 



436 ANATOMY. 

What bones articulate with the vomer? 

Sphenoid, ethmoid, 2 palate, 2 maxillae. 
Describe the sphenoidal fissure. 

Is located between orbital and cranial cavities, a triangu- 
lar gap between the greater and lesser wings of sphenoid 
bone. Its inner end is broad and rounded, its outer, narrow 
and pointed; its long axis extends outward, forward and 
upward. It transmits the 3d, 4th, the 3 branches of the 
ophthalmic division of the 5th cranial nerves, and the oph- 
thalmic vein. 

Describe the glenoid fossa. 

Is found upon under surface of temporal bone behind arti- 
culating eminence and in front of tympanic plate; is crossed 
by Glaserian fissure; posterior part receives upper end of 
parotid gland and anterior part receives condyle of mandible. 

What nerve and artery pass through the foramen ovale 
of the sphenoid bone? 

Mandibular division of 5th cranial; small meningeal 
branch of internal maxillary artery. 

Mention the muscles attached to the inferior maxillary 
bone. 

Fif ten pairs : levator menti, depressor labii inferioris, de- 
pressor anguli oris, platysma myoides, buccinator, masseter, 
orbicularis oris, genio-hyo-glossus, genio-hyoid, mylo-hyoid, 
digastric, superior constrictor, temporal, internal and external 
pterygoids. 

Mention the principal veins of the head and neck. 

Frontal, angular, facial, internal maxillary, temporo-maxil- 
lary, ophthalmic ; superior longitudinal, inferior longitudinal, 
straight, lateral, occipital, superior and inferior petrosal, 
transverse, circular and cavernous sinuses; external, anterior 
and internal jugular and vertebral veins. 



K 



ANATOMY. 437 

What muscles are attached to the basilar process of the 
occipital bone? 

Rectus capitis anticus major and minor, and superior con- 
strictor of pharynx. 

Give the boundary of the anterior triangle of the neck. 

Is bounded anteriorly by line extending* from chin to 
sternum ; behind by anterior margin of sterno-mastoid muscle ; 
above by lower border of body of mandible and line extended 
posteriorly to mastoid process. 

Mention the muscles attached to the outer surface of 
the malar bone. 

Levator labii superioris, zygomaticus major and minor. 
Describe the sigmoid notch. 

Situated between condyle and coronoid process of mandi- 
ble; transmits masseteric vessels and nerves. 

Mention the branches of the maxillary portion of the 
internal maxillary artery. 

Tympanic, middle meningeal, small meningeal and inferior 
dental. 

Mention the branches of the posterior auricular artery. 

Stylo-mastoid, auricular, mastoid. 

Give the branches of the internal maxillary artery. 

From the maxillary portion : tympanic, middle meningeal, 
small meningeal, inferior dental. From the pterygoid por- 
tion : deep temporal, buccal, pterygoid, masseteric. From 
the spheno-maxillary portion: alveolar, infra-orbital, de- 
scending palatine, vidian, ptery go-palatine, sphenopalatine. 

Describe the Gasserian ganglion. 

Is developed upon the sensory root of the 5th cranial nerve, 
and is located in a depression on the petrous bone near its 
apex, cranial surface. From its anterior margin 3 divisions, 
the ophthalmic, maxillary and mandibular pass through the 
sphenoidal fissure, the foramen rotundum and the foramen 



438 ANATOMY. 

ovale, respectively. The motor root of this nerve rests upon 
the petrous bone beneath the sensory root, uniting with the 
mandibular division after it has passed through the fora- 
men ovale. 

Give the origin and insertion of the sternothyroid 
muscle. 

From the manubrium sterni and the cartilage of the 1st rib, 
into the oblique ridge of the thyroid cartilage. 

Describe the mylo=hyoid muscle, giving its origin and 
insertion. 

It forms, with the opposite mylo-hyoid, the floor of the 
mouth. Origin, is from the mylo-hyoid ridge of the mandible ; 
insertion, into the body of the hyoid bone, meeting its fellow 
in a median raphe. 

Nerve, mylo-hyoid, a branch of inferior dental; action, to 
carry tongue upward and forward. 

Mention the orbital branches of the ophthalmic artery. 

Lachrymal, muscular, anterior and posterior ethmoidal, 
supra-orbital, frontal and nasal. 

Describe the temporal fossa. 

Is bounded above by temporal ridge, below by pterygoid 
ridge on great wing of sphenoid and extends from external 
angular process of frontal to a point above mastoid bone. It 
is formed by parts of five bones : sphenoid, frontal, temporal, 
parietal and malar. It gives origin to the temporal muscle. 

Describe the great wing of the sphenoid bone. 

A large, strong process, extending from the side of the 
body of the sphenoid outward, forward, upward and back- 
ward, and continued behind into a sharp, pointed extremity, 
its spinous process, which contains the foramen spinosum, 
transmitting the middle meningeal artery. Its upper surface 
is concave for the temporal lobe of the cerebrum; its external 
surface forms part of temporal and of zygomatic fossae, which 
are separated by the pterygoid ridge. The greater wing 



ANATOMY. 439 

presents 2 important foramina, viz., foramen ovale and fora- 
men rotundum; it forms the lower margin of the sphenoidal 
fissure and the upper boundary of the spheno-maxillary 
fissure. 

Give the course and distribution of the arteries and 
nerves which supply the upper alveolar arch. 

Arterial supply is derived from alveolar or posterior dental 
branch of internal maxillary, which sends branches into pos- 
terior dental canals to supply molar and bicuspid teeth and 
lining of antrum ; also from anterior dental branches of infra- 
orbital, which descend through anterior dental canals in wall 
of maxilla to be distributed to incisor and canine teeth. 

Nerve supply comes from posterior superior dental branches 
of superior maxillary division of the 5th cranial, which enter 
posterior dental canals, to be distributed to posterior teeth 
and to communicate with middle superior dental branch of 
superior maxillary nerve which passes down through special 
canal in outer wall of antrum, and with anterior superior 
dental nerve, another branch of superior maxillary nerve 
which enters a canal in anterior wall of antrum, these 
branches supplying the teeth in their respective regions. 

Describe the lesser wings of the sphenoid bone. 

They rise from the anterior superior surface of the 
sphenoidal body to which they are attached by 2 roots enclosing 
the optic foramen, which transmits the optic nerve and oph- 
thalmic artery. The superior surface is smooth and flat, 
broad internally and tapering to a point externally, and sup- 
ports part of the frontal lobe of the brain. The under sur- 
face forms the upper boundary of the sphenoidal fissure, and 
the posterior border is received by the fissure of Sylvius. 

Describe the palatine surface of the superior maxillary 
bone. 

Is formed by the palate process which projects horizontally 
inward to articulate with palate process of the opposite bone, 
and with palate bone posteriorly. Tts inferior surface is 



440 ANATOMY. 

slightly concave and rough for muco-periosteal covering of 
roof of mouth. When both superior maxillary bones are arti- 
culated, a large orifice, the anterior palatine canal, is formed 
just behind the incisor teeth in the median line. On the un- 
der surface of the palate process may sometimes be seen 
the intermaxillary suture, extending from the anterior pala- 
tine foramen to between the lateral incisor and canine tooth. 
This indicates the line of union between the maxilla and the 
intermaxillary, (premaxillary, or incisive) bone. 

Describe the submaxillary triangle. 

Is bounded, above, by lower border of body of mandible and 
a line drawn from its angle to the mastoid process; below by 
the posterior belly of the digastric; in front by the median 
line. Its floor is formed by mylo-hyoid and hyo-glossus 
muscles. It contains the submaxillary gland, facial artery 
and vein, submental artery and mylo-hyoid artery and nerve ; 
more posteriorly is the external carotid artery; more deeply 
are the internal carotid artery, internal jugular vein and 
the pneumogastric nerve. 

Describe the middle cerebral artery. 

Is a branch of the internal carotid, given off at the an- 
terior perforated space, and courses outward, upward and 
backward in the fissure of Sylvius. Its branches are : Antero- 
lateral ganglionic, (including the lenticulo-striate) inferior 
external frontal, ascending frontal, ascending parietal, 
parieto- temporal. 

Mention the facial branches of the facial artery. 

Muscular, inferior labial, superior and inferior coronary, 
lateral nasal and angular. 

Describe the lateral sinuses. 

Right and left lateral sinuses commence at internal occipi- 
tal protuberance, right being formed by superior longitudinal 
sinus, left by straight sinus; are located in attached margin 
of tentorium and groove of occipital, of parietal, of mastoid 
and then of occipital bone, again leaving cranial cavity through 



ANATOMY. 441 

jugular foramen, just outside of which they unite with inferior 
petrosal sinus to form internal jugular vein. 

Mention the muscles attached to the superior maxil- 
lary bone. 

Twelve: orbicularis palpebrarum, levator labii superioris 
alaeque nasi, inferior oblique, levator labii superioris, levator 
anguli oris, compressor naris, depressor alae nasi, dilatator 
naris posterior, orbicularis oris, buccinator, masseter and in- 
ternal pterygoid. 

Describe the supraorbital artery. 

Is a branch of ophthalmic artery, passes forward between 
levator palpebrae and periosteum of orbital roof to supra- 
orbital foramen, where it appears on external surface of 
frontal bone and divides into superficial and deep branches 
supplying integument, muscles and epicranial aponeurosis, 
anastomosing with temporal, frontal and opposite supra- 
orbital. 

Mention the vessels and nerves that supply the sub- 
maxillary gland. 

Facial artery, facial vein; nerves from submaxillary 
ganglion, which is formed by branches from chorda tympani, 
lingual and from sympathetic plexus around facial artery. 

Describe the Island of Reil. 

Also called central lobe, is deeply placed in Sylvian fissure, 
is of pyramidal shape and consists of 6 or 7 convolutions. 

State the formation and course of the inferior vena cava. 

Is formed on right side of 5th lumbar vertebra by union of 
the 2 common iliac veins. It rests upon bodies of lumbar 
vertebrae, lying to right of aorta, grooves posterior surface 
of liver, and passes through caval opening in diaphragm to 
terminate in right auricle. 

State the origin, exit, distribution and functions of the 
pneumogastric nerve. 

Superficial origin from side of medulla in groove between 



442 ANATOMY. 

olivary and restiform bodies; exit through jugular foramen; 
distributed to posterior part of auricle and external auditory 
meatus, motor nerve to pharynx, sensory and motor to larynx, 
helps to form superficial (left nerve) and deep cardiac 
plexuses, furnishes pulmonary, oesophageal and gastric 
branches. 

Describe the cavernous sinus. 

So named from being traversed by interlacing filaments. 
Is placed on side of body of sphenoid bone and extends from 
sphenoidal fissure to apex of petrous bone. It receives opthal- 
mic vein anteriorly, terminates in petrosal sinuses posteriorly, 
and communicates with opposite cavernous sinus through cir- 
cular sinus. The following structures pass through it: 3d, 
4th and ophthalmic division of 5th nerves, 6th nerve and in- 
ternal carotid artery. 

Describe the thyroid gland. 

It consists of right and left lobes connected by an isthmus 
across 2d, 3d and 4th tracheal rings; has a capsule and trabe- 
cule surrounding closed follicles, which contain colloid ma- 
terial. Arterial supply comes from superior and inferior 
thyroid arteries ; thyroid veins drain it. It is intimately at- 
tached to trachea and alae of thyroid cartilage, and rises 
and falls with larynx. 

Bound the occipital triangle. 

In front, by sterno-mastoid muscle; behind, by trapezius; 
below, by posterior belly of omo-hyoid ; apex of triangle is at 
occiput. 

Describe the outer surface of the occipital bone. 

Is convex, smooth above, rough below. Superior curved 
line extends transversely, with external occipital protuber- 
ance at center; from latter, external occipital crest passes 
downward to posterior margin of foramen magnum, and meets 
inferior curved line half way down. Antero-lateral mar- 
gins of foramen magnum are bounded on either side by occi- 
pital condyles, in front of which is anterior condyloid foramen, 



ANATOMY. 443 

and behind which is posterior condyloid foramen. Under 
surface of basilar process is rough for muscles, and presents 
pharyngeal spine at its center. Margins are roughly serrated, 
jugular processes extend laterally. 

From how many centers of ossification is the temporal 
bone developed? 

Ten. 

What is an aponeurosis? 

It is a more or less broad, flat sheet of fibrous tissue to 
which muscular fibers are attached, serving as a tendon of 
insertion for these fibers. 

Describe the horizontal plate of the palate bone. 

Is quadrilateral and presents 2 surfaces and 4 borders. 
Superior surface is smooth and slightly concave from side 
to side, forming posterior floor of nose; inferior surface is 
rough, forms posterior part of roof of mouth, and at outer, 
posterior angle is deeply grooved to help form posterior 
palatine canal. Anterior border is serrated to articulate with 
palate process of superior maxillary bone; posterior border 
is smooth, concave, and gives attachment to soft palate ; in- 
ternal border is thick and serrated for articulation with op- 
posite horizontal plate; external border joins perpendicular 
part of palate bone. 

What are the bones of Bertin? 

The sphenoidal turbinals, 2 in number, hollow, pyramidal, 
attached to anterior surface of body of sphenoid, near ros- 
trum; they form the roof of each nasal cavity and a small 
part of the inner wall of the spheno-maxillary fossa. 

Define veins, arteries, lymphatics. 

Veins are tubular parts of the blood-vascular system carry- 
ing venous blood from all parts of the body toward the right 
auricle, or arterial blood from the lungs toward the left 
auricle; their walls are thin and their tunica intima forms 
reduplications, or valves, in some veins. 



444 ANATOMY. 

Arteries are vessels carrying blood away from the heart, — 
arterial in all cases except in the pulmonary artery, where 
the blood is venous, en route to the lungs; the wall of the 
artery is relatively thick. 

Lymphatics are vessels which convey lymph from all parts 
of body to venous circulation at base of neck, on each side; 
lymphatics of mesentery are called lacteals. 

Describe the ophthalmic vein. 

There are 2 ophthalmic veins, superior and inferior. Su- 
perior ophthalmic vein connects angular vein at inner angle 
of orbit with cavernous sinus; it takes the same course as 
the ophthalmic artery, receiving tributaries from upper or- 
bital contents. The inferior ophthalmic vein drains the floor 
of the orbit, passing through spheno-maxillary fissure to end 
in pterygoid plexus of veins, or through sphenoidal fissure 
to terminate in cavernous sinus. 

Mention the branches of the inferior thyroid artery. 

Inferior laryngeal, tracheal, esophageal, ascending cervical, 
muscular. 

Give the articulations of the ethmoid bone. 

With 15 : sphenoid, 2 sphenoidal turbinated, frontal, 2 
superior maxillary, 2 lachrymal, 2 nasal, 2 palate, 2 inferior 
turbinated, and vomer. 

Describe the medulla oblongata. 

Is a part of encephalon, continuous with spinal cord be- 
low and with pons above; it rests upon basilar process of 
occipital bone, consists of white nerve matter externally and 
gray matter arranged irregularly, internally, the latter ap- 
pearing upon the surface in floor of 4th ventricle, the lower 
half of which is formed by medulla; upon ventral surface 
is anterior median fissure, partially obliterated below by de- 
cussation of crossed pyramidable tracts; near anterior part 
of inferior surface are olivary bodies; posterior columns di- 
verge to form calamus scriptorius and to bound 4th ven- 
tricle laterally for its lower half; postero-laterally are resti- 



ANATOMY. 445 

form bodies which can be traced upward into cerebellum, 
forming inferior peduncles of latter. Cranial nerves from 
7th to 11th inclusive arise from side of medulla, while 12th 
appears upon surface in groove between olivary body and 
anterior pyramid. 

Give the articulations of the lachrymal bones. 

With 4 bones : frontal, ethmoid, superior maxillary and in- 
ferior turbinated. 

Mention the muscles and ligaments attached to the 
ramus of the jaw. 

Masseter, temporal, external and internal pterygoids; liga- 
ments are capsular (external lateral), internal lateral 
(spheno-mandibular), and stylo-mandibular. 

Mention the vessels and nerves supplying the parotid 
gland. 

Arteries are derived from external carotid; veins, tribu- 
taries to external jugular; lymphatics terminate in super- 
ficial and deep cervical nodes; nerves are derived from facial, 
auriculotemporal, great auricular, and sympathetic plexus 
on external carotid artery. 

Describe the 9th (glosso=pharyngeal) nerve. 

Arises from groove between olivary and restiform bodies, 
passes out of cranial cavity through jugular foramen, divides 
into lingual and pharyngeal branches, supplying mucous 
membrane of posterior part of tongue (circumvallate papillae) 
and mucous membrane of pharynx. A branch (Jacobson's) 
is distributed to tympanum. 

Describe briefly the 5th nerve. 

Superficial origin of both motor and sensory roots is from 
pons near anterior margin; Gasserian ganglion develops on 
sensory root and rests on apex of petrous bone, now forming 
3 divisions, ophthalmic, maxillary and mandibular ; ophthalmic 
division divides into frontal, nasal and lachrymal branches, 
which leave cranial cavity by sphenoidal fissure; maxillary 



446 ANATOMY. 

division leaves cranial cavity by foramen rotundum, crosses 
spheno-maxillary fossa, enters orbit, terminating as infra- 
orbital nerve ; mandibular division and motor root leave cran- 
ial cavity by foramen ovale, unite and then divide to supply 
muscles of mastication with motor influence, and anterior 
part of auricle, lower jaw and part of tongue with sensory 
influence. 

Give a general description of the alimentary canal, nam= 
ing its successive divisions. 

Its parts, in order, are : mouth, pharynx, esophagus, 
cheek walls, with buccal orifice directed transversely; con- 
intestine (caecum, ascending, transverse, descending and sig- 
moid colons, rectum, and anal canal). 

Mouth is composed of upper and lower jaws covered by 
cheek walls, with buccal orifice directed transvelsely ; con- 
tains tongue, at base of which are fauces with anterior 
and posterior pillars and tonsils. 

Pharynx joins esophagus at lower border of cricoid carti- 
lage; esophagus is 10 inches long and passes through dia- 
phragm to be continued into stomach. 

Stomach occupies epigastric and left hypochondriac re- 
gions and presents a cardiac and a pyloric extremity and a 
greater and a lesser curvature. Its wall consists of 4 coats, 
viz., serous, muscular, areolar and mucous. 

Duodenum is fixed and curved around head of pancreas; 
common bile and pancreatic ducts open into it; jejuno-ileum, 
attached to posterior abdominal wall by mesentery, extends for 
20 feet, or more, to ileo-caecal junction, where it joins 
large intestine; vermiform appendix is attached to caecum 
(usually inner side), below ileo-caecal valve; ascending colon 
passes to liver, forms hepatic flexure; transverse colon, with 
great omentum attached, crosses to spleen and forms splenic 
flexure; descending colon reaches left iliac fossa and is con- 
tinued into sigmoid which curves around into pelvis, resting 
on sacrum; rectum curves forward and anal canal, guarded 
by internal (involuntary) and external (voluntary) sphinc- 
ters, opens downward and slightly backward. 



ANATOMY. 447 

Give the origin, course and distribution of the great 
sciatic nerve. 

Origin from lower lumbar and upper sacral nerves (sacral 
plexus) ; course, through great sacro-sciatic foramen below 
pyriformis muscle, from beneath lower margin of gluteus 
maximus midway between trochanter major and tuber ischii, 
rests upon adductor magnus and divides about middle of 
thigh into internal and external popliteal nerves; it supplies 
semitendinosus, semimembranosus, adductor magnus and 
biceps. Internal popliteal is continued down leg as posterior 
tibial, distributed to back of leg and sole of foot; external 
popliteal curves around below head of fibula to front of leg, 
becoming anterior tibial to front of leg and dorsum of foot. 

Describe the anatomical position of the thoracic duct, 
(b) Where does it terminate? (c) What does it convey? 

Thoracic duct begins in receptaculum chyli on body of 
2d lumbar vertebra, to right of aorta, passes through aortic 
opening of diaphragm into posterior mediastinum, (b) It 
terminates at junction of left internal jugular and left sub- 
clavian veins, (c) It conveys lymph and chyle. 

Give the origin, insertion and nerve supply of the stylo- 
glossus muscle. 

Origin, from styloid process of temporal bone; insertion 
into side of tongue; nerve, hypoglossal. 

Bound the superior carotid triangle. 

Behind, by sterno-mastoid ; below, by anterior belly of omo- 
hyoid ; above, by posterior belly of digastric. 



INDEX. 



Abrasion of the teeth, 7, 196 
Abscess, 131, 173, 179 

Alveolar, 28,117, 165,195, 

198 
Apical alveolar, 188 
Blind, 28 

Chronic alveolar, 156 
Pericemental, 27, 120 
of temporary teeth, 196 
Abscessed deciduous tooth, 33 
Absorption, 257 

of food, 369 
Accidents in extracting teeth, 31 
Acids, 265 

Aconite, 207, 209, 245 
Acquired cleft palate, 146 
Acute arthritis, 166 
periostitis, 163 
ranula, 101 
Adhesion, 254 
Adipose tissue, 323 
Aerobic bacteria, 185 
Afferent nerves, 375 
Alcohol, 291, 370, 374, 400 
Alimentary canal, 446 
Alkali, 270 

Alkalies in dentistry, 213 
Alkaline, 251 
Alkaloids, 270, 290, 292 
Alloys, 298 
Alteratives, 238 
Aluminum, 314 

in dentistry, 59 
solder, 60 
Alveolar abscess, 117, 156, 165, 195, 
198 
arch, 439 
dental abscess, 28 
process, 365 

Cysts of, 186 
Necrosis of, 153 
Amalgam, 294, 300, 313 

and cement filling, 17 
copper, 311 
fillings, 9 
Amalgamation process, 307 



Ameloblasts, 329, 348 

Amianth, 315 

Ammonia, 281 

Amputation of the root, 28 

Amyl nitrite, 210, 239 

Amyloid foods, 363 

Anaerobic bacteria, 185 

Analgesic, 232 

Analysis, 265, 269, 288 

Analytical chemistry, 274 

Anatomy, 413 

morbid, 188 

Anchorage for gold fillings, 13 

Anemia, 184 

Anesthesia, 97, 125 

Anesthetics, 232 

General, 210 
Local, 130, 219, 242 

Aneurysm, 173 

Angle method, 87, 169 

Anhydride, 250 

Anhydrous, 250 

Animal life, 273 

Ankylosis, 119 

False, 136 

Annealing, 296 

Anode, 257 

Anterior cervical triangle, 437 

Antidote, chemical, 226 

Antimony, Test for, 302 

Antiphlogistic, 215 

Antipyretics, 237 

Antisepsis, 180 

Antiseptics, 201, 211 

Antitoxin, 181 

Antral disease, 112 

Antrum, Empyema of, 127, 150 

Antrum, Tumors of, 126 

Aorta, 430 

Aphthae, 116 

Aphthous stomatitis, 116 

Apical alveolar abscess, 188 

Aponeurosis, 443 

Approximal cavities, 4 

Aqua regia, 284 

Aqueous solutions, 215 



29 



(449) 



450 



INDEX. 



Arrested development of maxillae, 

169 
Arsenic, 23. 148, 203, 208, 245, 246, 
301 
necrosis, 120 
Arsenious acid, 214, 215 
Arterial hemorrhage, 98 
Arteries, 344, 365, 378, 444 

Wounds of, 138 
Arthritis, 136 

Acute, 166 
Articular cartilage, 345 
Articulation, Temporo- maxillary, 

110 
Artificial crowns, 19 
dentine, 51 
respiration, 148 

direct method, 
122 
teeth, 44 
velum, 89 
Asbestos, 315 
Asepsis, 172, 180 
Aseptic wounds, 141, 166 
Asepticism of cavities, 8 
Asphyxia, 137 

Mechanical, 108 
Assay, 287 
Assimilation, 368 
Astringents, 238 
Atmospheric air, 282, 407, 408 
Atom, 269 

Atomic weight, 269, 270 
Atrophy, 179 
Atropine poisoning, 227 
Avogadro's law, 263 
Axis cylinder, 340 

process, 337 

Babbitt metal, 58 
Bacilli, 185 

Bacteria, 176, 180, 183, 184, 185, 
199, 201 

Diseases due to, 186 

Parasitic, 194 

Pathogenic, 175, 181,190 

Saprophytic, 204 
Bacterial cell, 174 
Bandage, Barton's, 133 
Bandage, Four-tailed, 134 
Bandage, Gibson's, 139 
Banded Logan Crown, 72 
Barton's bandage, 133 
Base, Celluloid, 56 
metal, 297 



Base plate, 44 

Vulcanite, 51 
Bathing, 368, 397 
Belladonna, 227 
Benign tumors, 175, 178 
Bertin 's bones, 443 
Bicuspid crown, 75 

jacket crown, 75 
Bile, 361 
Bioplasm, 344 

Blackening of gold fillings, 15 
Blastoderm, 342 
Bleaching, 284 

of the teeth, 26 
Blind abscess, 28 
Blood, 340, 362, 371 

-plasma, 386 

-platelets, 317 
Blowpipe, Knapp, 93 
Blue vitriol, 285 
Body-temperature, 359, 361 
Bone, 287, 335, 347, 366 
Bonwill articulator, 92 

crown, 74 
Bony consolidation after fracture, 

95 
Bridges, 19 
Bridge, Removable, 83 

-work, 81 
Bromine, 278 
Brophy's operation, 151 
Brown's porcelain bridge, 85 
Buccal cavity, Carcinoma of, 157 
Buccinator, 417 
Biittner crown, 80 
Bunsen burner, 253 
Burs, 3 

Cachexia, 183 
Calcification, 351 

of teeth, 340 
Calculus, Salivary, 37, 138, 146, 165, 
189, 201 
Sanguinary, 37, 191 
Serumal, 191 
Callus, Definitive, 178 

Intermediate, 178 
Provisional, 177 
Calomel, 312 
Canal, Pulp, 24 
Root, 24 
Canaliculi, 347 
Cancrum oris, 116 
Candle flame, 252 
Cap, Gold, 77 .-■•■< 



INDEX. 



451 



Capillaries, 352, 365, 378 

Capillary attraction, 257 

Capping of pulp, 22, 194 

Capsicum, 217 

Carat, 304 

Carbolic acid, 126, 209, 241 

poisoning, 225 
Carbon, 279 

dioxide, 280 
Carcinoma, 17z, 176, 182 

of buccal cavity, 157 
tongue, 96, 159 
Carcinomatous ulcer, 190 
Care of teeth in children, 35 
Caries, 143, 204 

Dental, 1, 195, 199 
fungosa, 164 
necrotica, 164 
of maxillse, 163 
sicca, 163 
suppurativa, 163 
Cartilage, 323, 327, 351 
Case's appliance, 88 

retainer, 88 
Casein, 375 
Cast-iron, 309 
Cataphoresis, 225, 233 
Cataphoric applications, 211 
Catarrhal inflammation, 177 
Cathartics, 221 , 237 

saline, 244 
Cathode, 258 
Causes of disease, 185 
Cavernous sinus, 442 
Cavities, Approximal, 4 
Asepticism of, 8 
Cervical, 5 
Excavation of, 3 
Formation of, 2 
Preparation of, 2 
Protectk 
Cavity-margins, 3 
Cell, 334 

Bacterial, 174 
Cellulitis, 167 

Suppurative, 100 
Celluloid, 57 

base, 56 
Cement, 9 
Cementoblasts, 346 
Cementum, 333 
Centers of ossification, 326 
Cerebellum, 414 
Cerebrospinal axis, 358 
Cerebrum, 363 



Cervical cavities, 5 
Chemical affinity, 273 
antidote, 226 
composition of muscle, 

385 
compound, 271, 274 
equation, 266 
reaction, 266 
Chemistry, 249 
Cheoplastic process, 57 
Chlorine, 278 

Chloroform, 218, 223, 230, 232, 245, 
290 
Syncope under, 160 
Chromogenic bacteria, 184 
Chronic alveolar abscess, 156 

inflammation, 148 
Cilia, 318 
Cinnabar, 311 
Circle of Willis, 432 
Circuit, 258 

Circulation of the blood, 355 
Circulatory apparatus, 377 
Clasp gold, 67 
Cleansing the teeth, 39 
Cleaveland vacuum-cavity, 46 
Cleft palate, 89, 111, 145, 151, 178 
Acquired, 146 
Operation in, 95 
Cocaine, 220, 222, 239, 247 

poisoning, 225 
Cocci, 185 
Cohesion, 253 
Cohesive gold, 12 
Cold bath, 396 

inflammation, 95 
Collapse, 225, 247 
Color of teeth, 26 
Columnar epithelium, 322 
Columns of the spinal cord, 387 
Combination fillings, 15 
Combined gold fillings, 14 
Combustion, 275 
Compact bone, 339 
Compound, 267, 272 

fracture of inferior 

maxilla, 114, 161 
molecule, 271 
Conductors of electricity, 255 
Congenital dislocation, 139 
Congested pulp, 20 
Connective tissue, 319, 321, 383, 

337, 352, 413 
Contamination of drinking-water, 
391 



452 



INDEX. 



Continuous gum denture, 68 
Contused wounds, 96 
Copper, 298 

amalgam, 311 

sulphate, 243 
Cores, 58 

Corrosive sublimate, 312 
Cottonoid, 5 
Counter-die, 58 

-irritants, 207 
Countersunk-pin Teeth, 48 
Cremation, 399 
Creasote, 216, 241 
Crib, Jackson, 86 
Crooked buccal root-canals, 25 
Crown, Artificial, 19 

Bicuspid, 75 

Bicuspid jacket, 75 

Bonwill, 74 

Biittner, 80 

Davis, 78 

Logan, 72 

Mason, 76 

Pin, 85 

Richmond, 73 

Shell, 76 
Crude rubber, 49 
Culture medium, 184 
Cylindric epithelioma, 135 
Cyon and Ludwig's nerve, 357 
Cystic dilatation of Steno's duct, 

106 
Cysts, 131, 140 

of the alveolar process, 186 
Dental, 186 

Dentigerous, 103, 115, 186 
Multilocular, 146, 186 
of the tongue, 101 

Dark joints in gum teeth, 49 

Davis crown, 78 

Dead pulp, 24 

Decay in deciduous teeth, 32 

under plate clasps, 6 

White, 4 
Deciduous teeth, 205 
Decoctions, 233 
Decomposition, 174 
Deep-seated dental caries, 1 
Definitive callus, 178 
Deglutition, 359 
Deliquescence, 249 
Dental calcification, 346 
Dental caries, 1, 195 
cysts, 186 
exostosis, 198 



Dental fibrillse, 350 
follicle, 349 
neuralgia, 20 
orthopedia, 35 
papilla, 348 
pulp, 374 
ridge, 341 
shock, 6 
tubuli, 331 
Dentifrices, 214, 233 
Dentigerous cysts. 103, 115, 186 
Dentine, 292, 348 

Highly inflamed, 6 
Hypersensitive, 202 
Secondary, 7 
Dentistry, Operative, 1 

Prosthetic, 41 
Dentition, Pathological, 194 
Deodorants, 236 
Deposits on teeth, 36 
Dermoid cysts, 141 
Destructive distillation, 255 
Devitalization of pulp, 23 

of teeth, 196 
Diad, 264, 272 
Diagnosis, 188 
Diamond, 280 
Diaphoretics, 224 
Diathesis, 183 
Diatorii 
Die, 58 
Diffusible stimulants, 244 
Diffusion, 257 
Digastric muscle, 429 
Digestion, 353 
Digitalis, 212, 228 
Diphtheria, 401, 408 

-infection, 389 
Direct method of artificial respir- 
ation, 122 
Disease, Causes of, 185 

of dental pulp, 194 
Diseases due to bacteria, 186 
of maxillse, 176 
of pericementum, 202 
Disinfectants, 208, 211, 389 
Disinfecting lotions, 155 
Disinfection, 182, 389, 390 
of hands, 129 
Dislocations, 109, 138, 143 

Traumatic, 121 
Displacement, 130 
Diuretics, 224 

Double fracture of inferior max- 
illa, 151 
Dowel, 85 



INDEX. 



453 



Drinking - water, Contamination 

of, 391 
Dry-earth svstem, 392 
Ductility, 250 

Eburnation, 8 
Efferent nerves, 875 
Effervescence, 250 
Efflorescence, 249 
Elbow-joint, 425 
Elastic tissue, 338 

fibrous tissue, 319 
Electric current, 258 
Elasticity, 250, 258 
Electricity in dentistry, 39 
Electrolysis, 269 
Electro-magnet, 256 
Electro-motive force, 258 
Electroplating, 252 
Element, 267, 268 
Embolism, 175 
Embolus, 173 
Embryology, 342 
Emetics, 225, 236 

Empyema of the antrum, 127, 150, 
216 
of maxillary sinus, 179 
Enamel, 292, 329, 332, 348 

organ, 350 
Enchondronal bone, 338 
Endemic diseases, 410 
Endocardium, 324 
Endoneurium, 317 
Endosmosis, 378 
Endothelium, 352 
Energy, 255 
English Tube teeth, 64 
Epidemic diseases, 410 
Epiglottis, 365 
Epineurium, 317 
Epistaxis, 124 
Epithelioma, 135 

of the lips, 129 
Epithelium, 335, 343, 344, 352 
Epulic tumors, 115 
Epulis, 115, 178, 197 
Ergot, 228 
Erosion, 132 

of teeth, 7, 204, 379, 380 
Eruption of Teeth, 202 
Erythrocytes, 340 
Escharotics, 210, 215 
Essential oils, 209 
Ether, 230, 233, 245 
Ethmoid bone, 417 



Ethyl bromide, 220, 235 

chloride, 218 
Ethylic alcohol, 291 
Etiology, 188 
Eucaine, 220 
Examination of teeth, 38 
Excavation of cavity, 3 
Excavator points, 3 
Exhumations, 397 
Exosmosis, 378 
Exostosis, 30, 191, 196 
Dental, 198 
Expansion of the upper arch, 36 
Expectorants, 224 
Exposed pulp, 20. 33 
External fistula, 113 

jugular vein, 418 

of teeth, 30 

of deciduous teeth, 32 

of molar teeth, 104 

Facial artery, Ligation of, 96 
nerve, 118, 442 
vein, 435 
Facultative bacteria, 185 
False ankylosis, 136 
Farrar's System, 86 
Fatty tumor, 131 
Feeble pulse, 158 
Fermentation, 188, 290 

Lactic, 200 
Fibrin, 318 
Fibro-cartilage, 322 
Fibrous epulis, 178 
Fifth nerve, 445 
Filling, Amalgam, 9 

and cement, 17 
Cohesive gold, 12 

and non-cohe- 
sive gold, 14 
Combination, 15 
of deciduous teeth, 33 
gold, 2, 11 

and amalgam, 16 
and cement, 16 
and tin, 16 
Gutta-percha, 9 

and zinc phos- 
phate, 15 
-materials, 8 
Metallic. 314 
Non-cohesive gold, 13 
Plastic, 10 
Porcelain, 18 
of pulp-canals, 24 



454 



INDEX. 



Filling, Tin, 11 
Fistula, 133 

External, 113 
Salivary, 142, 166 
Fixed oils, 233 
Fluid extracts, 235 
Fluorine, 278 
Flux, 62, 300 
Food, 376, 390, 403 
Force, 255 

Foreign body in the nose, 154 
Formaldehyde, 213, 234 

-disinfection, 390 
Formation of Cavities, 2 
Formula, 271 
Four-tailed bandage, 134 
Fracture, 107, 119 

of mandibular condyle, 
150 

of inferior maxilla, 91, 
96,101,128 

of superior maxilla, 128. 
169 
Fractures, Repair of, 186 
Frequent pulse, 171 
Frontal bone, 419 
Function, 370 
Fungi in mouth, 200 
Fungoid pulp, 25, 197 
Furbinger's method, 129 

Galvanic cells, 251 
Ganglion, 334, 385 
Gangrene, 98 

Gangrenous stomatitis, 116, 186 
Gasserian ganglion, 437 
Gastric juice, 354, 372 
Gastrocnemius, 415 
Gelatine plates, 175 
General anesthetics, 210 
pathology, 185 
Genio-hyo-glossus muscle, 428 
Germicides, 201 , 236 
Germs, 181 

Germ-theory of disease, 404 
Giant cells, 326 
Gibson's bandage, 139 
Gingivitis, Marginal, 122 

Syphilitic interstitial, 
122 
Glacial phosphoric acid, 288 
Glenoid fossa, 436 
Glossopharyngeal nerve, 445 
Glottis, Obstruction of, 153 
Glycogen, 382 



Gold, 298 

and amalgam filling, 16 

bridge, 81 

cap, 77 

and cement filling, 16 

clasps, 67 

Cohesive, 12 

fillings, 2, 11 

Anchorage for, 13 
inlays, 19 
^Ton-cohesive, 12 
plate, 66 
Refining of, 303 
and silver plates, 60 
Test for, 302 
and tin filling, 16 
Grain alcohol, 291 
Graphite, 280 
Gravitation, 254 
Green stain. 33 
Grenet cell, 251 
Grove cell, 251 
Gum-boil, 165 
Gumma of mouth, 133 
of tongue, 159 
Gums, Hemorrhage from the, 142 
Hypertrophy of, 113 
Papilloma of, 126 
Spongy, 120 
Tumors of, 111 
Gustatory nerve, 375, 433 
Gutta-percha, 9 

and zinc phosphate 
fillings, 15 
Gypsum, 286 

Haemo- ; see Hemo- 
Hammond wire splint, 107 
Hands, Disinfection of, 129 
Hand pressure, 17 
Hard pulse, 155 
water, 400 
Hardening of tissues, 318 
Hare-lip, 118, 149 
Haversian canals, 347 
system, 335 
Hawes molding-flask, 58 
Healing of wounds, 148, 183 
Heart, 324, 366, 368 

Mechanism of, 357 

Valves of, 370 
Heat, 146, 257 

in inflammation, 167 
Heating of houses, 403 
Hemoglobin, 333 



INDEX. 



455 



Hemorrhage, 109, 119, 126, 184 
Arterial, 98 
from the gums, 142 
from inferior dental 

canal, 151 
after lancing of 

gums, 111 
after tooth-extrac- 
tion, 32, 112 
Secondary, 99, 168 
from tongue, 136 

Hemostatics, 210 

Highly inflamed dentin, 6 

Highmore's antrum, 427, 432 

Histology, 317, 334 

House-plumbing, 390 

Hutchinson's teeth, 197 

Hydrate, 250 

Hydrochloric acid, 222, 261 

Hydrogen, 275 

dioxide, 234, 277 
peroxide, 210 

Hydrometer, 249 

Hygiene, 389 

Hyoid bone, 416 

Hyperemia, 184, 200, 203 

of the pulp, 123 

Hypersensitive dentine, 5, 202 

Hypertrophy, 181 

of the gums, 113 

Hypnotics, 235 

Hypoblast, 325 

Hypoglossal nerve, 363, 378, 422 

Idiosyncrasy, 207 

Immunity, 410 

Impacted wisdom tooth, 128 

Impaction of molar, 88 

Implanting, 29 

Implantation of teeth, 105 

Impressions, 41 

Impression of cleft palate, 89 

Incised wound, 143 

Incisor, Approximal cavity of, 5 

Incompatibility of drugs, 226 

Inductive force, 258 

Infectious osteomyelitis of inferior 

maxilla, 161 
Inferior dental artery, 433 
maxilla, 416, 429 

Compound frac- 
ture of, 114,161 
Fracture of, 91, 

96, 101, 128 
Infectious osteo- 
myelitis of, 161 



Inferior maxilla, Luxation of, 113 
Necrosis of, 161 
^Osteoma of, 99 
Periostitis of ,1 24 
Ununited frac- 
ture of, 136 
maxillary nerve, 431 
vena cava, 441 
Inflamed periosteum, 26 
Inflammation, 109, 172, 174, 193, 
200, 203 
Catarrhal, 177 
Causes of, 187 
Chronic, 148 
Cold in, 95 
Heat in, 167 
of mouth mem- 
branes, 1 
Pain in, 177 
Suppurative, 155, 

177 
Swelling in, 168 
Infusions, 233 
Inlays, Gold, 19 

Porcelain, 18 
Inorganic chemistry, 274 

compounds, 272 
Inspiration, 382 
Interglobular spaces, 348, 349 
Intermediate callus. 178 
Intermittent pulse, 155 
Internal jugular vein, 432 

maxillary vein, 435 
Interpolation, 130 
Intestinal digestion, 381 
Intramembranous bone, 339 
Investments, 84 
Involuntary muscles, 363 
Iodine, 208, 214, 278 ' 
Iodism, 224 
Iodoform, 211, 234 
Iridium, 301 
Iron, 208 

Irregular pulse, 158 
Irregularity of the Teeth, 35, 166 
Irritable pulp, 197 
Irritants, 213, 217 
Irritation of the pulp, 21 
Island of Eeil, 441 

Jackson crib, 86 

Kelly's method, 129 
Kidneys, 353 
Knapp blow-pipe, 93 
Knee-joint, 425 



456 



INDEX. 



Laborde's method, 148 
Lacerated wounds, 96, 136 
Lactic acid, 289 

fermentation, 200 
Lacunae, 324 
Lampblack, 280 
Lancing, 117 

of the gums, 32 

Hemorrhage 
after, 111 
Latent heat, 257 
Lateral sinuses, 440 
Laughing gas, 28, 220, 231, 245, 246 
Law of multiple proportions, 273 
Lead, 298, 314 
Leucocytes, 199. 330, 341 
Leukomains, 171 
Ligation of arteries, 123, 127 
of facial artery, 96 
of temporal artery, 97 
Lingual artery, 434 

carcinoma, 96 
nerve. 433 
Lip, Epithelioma of, 129 
Liquid nitrous acid, 220 
Liver, 360, 369 
Local anesthesia, 130, 219 
anesthetics, 208, 242 
hyperemia, 184 
treatment of hemorrhage, 
126 
Logan crown, 72 
Lunar caustic, 308 
Luxation of inferior maxilla, 113 
Lymphatic system, 358, 377 
Lymphatics,~333, 444 

Macroglossia, 149 
Magnets, 256 
Malignant tumors. 175 
Malleability, 250 
Mallet pressure, 17 
Mandible, 416 
Marginal gingivites. 122 

zone, 319 
Margins, cavity. 3 
Marrow, 320 
Mason crown, 76 
Mastication, 382 

muscles of, 429 
Mastoid bone, 420 
Materia medica, 207, 223 
Matrix, 17 
Matter, 255, 268 
Maxilla, fracture of, 169 



Maxillae, arrested development of, 
169 
caries of , 163 
diseases of, 176 
Maxillary sinus, 427, 432 

empyema of, 179 
suppuration of, 

106 
tumor of, 106 
Mechanical asphyxia, 108 
Mechanism of the heart, 357 
i Meckel's cartilage, 349 
! Medulla oblongata, 356, -144 
Medullary substance, 340 
Mercurial stomatitis, 134, 200 
! Mercuric chlorid. 194, 312 
i Mercury, 310, 312 
' Mesoblast, 340, 347 
Metabolism . 384 
Metallic compound, 294 

elements, 264, 294 
Metallurgy, 249. 293 
Metals, 293 
Method, Angle, 87 

of swaging, 59 
Methylic alcohol, 291 
Micro-organisms, ISO 

of pus, 174 
Middle cerebral artery, 440 
Milk, 376 

adulteration, 398 
sterilization, 400 
Miller's theory, 199 
Mixed diet. 411 
Mixture, 271 

Moist gangrene of the pulp, 121 
Molar, impaction of, 188 

teeth, extraction of, 104 
Molecular weight, 266 
Molecule, 269, 271 
Monad, 264, 272 
Morbid anatomy, 188 
Morphia, 245 
Mouth, gumma of, 133 

membranes, inflammation 

of, 1 
syphilis of, 130, 174 
tumors of, 135 
Mucous membranes, 345 

tissue, 338 
Multilocular cyst, 146, 186 
Mummification of dental pulp, 25 
Muriatic acid, 279 
Muscle, chemical composition of, 
385 



INDEX. 



457 



Muscles of mastication, 429 
the tongue, 434 

Muscular tissue, 342 

Mydriatics, 221 

Myeloid sarcoma, 127 

Mylohyoid muscle ,438 
nerve, 428 

Myocardium, 324 

Myxomatous tissue, 323 

Naphthol, 216 
Narcotics, 215, 235 
Nasal bones, 422 
Nasmyth's membrane, 323 
Nausea in prosthetic dentistry, 43 
Necrosis, 143, 197 

Arsenic, 120 
of alveolar process, 153 
inferior maxilla, 161 
the jaw, 98 
Phosphorus, 402 
Negative elements, 268 

metallic fillings, 314 
Nerve cells, 336 
Facial, 118 
fibers, 324, 325, 334 
Nerves of special sense, 385 
Nervous system, 375, 413 
Neuman's sheath, 351 
Neuralgia, 128 

Dental, 20 
Trifacial, 108, 164 
Neurasthenia, 102 
Neurilemma, 340 
Neuritis, 128, 137 
Neuro-epithelium, 339 
Neuroglia, 317 
Neutral, 251 
Nitric acid, 222 
Nitrogen, 282, 283 
Nitrous oxide gas, 218, 220, 231, 

245, 246, 
Noble metal, 297 
Non-cohesive gold, 12 

-conductors of electricity, 255 
-metallic elements, 264 
-virulent germ, 181 
Normal pulse, 367 
Nose, Foreign body in, 154 
Nuclear matrix, 332 
Nucleus, 332 
Nuisance, 396 
Nutrition, 372 
Nux vomica, 229 



Obstruction of the glottis, 153 
Obturator, 89 
Occipital bone, 442 

triangle, 442 
Occipito-frontalis, 434 
Occlusion of teeth, 54 
Odontalgia, 20, 147 
Odontoblasts, 331, 336 
Odontoma, 103 
Oil of cinnamon, 217 

cloves, 216 
Omohyoid muscle, 428 
Operation in cleft palate, 95 
Operations on syphilitics, 108 
Operative dentistry, 1 
Ophthalmic artery, 421 
nerve, 424 
vein, 444 
Opium, 229 

Oral mucous membrane, 320 
pathology, 176 
surgery, 95 
Organic chemistry, 274 

compounds, 272 

tissue, 333 
Orthodontia, 98 
Orthophosphoric acid, 288 
Osmose, 257 
Os planum, 429 
Osteoblasts, 320, 339 
Osteoclasts, 339, 346 
Osteoma of inferior maxilla, 99 
Otic ganglion, 421 
Overstrain, 399 
Oxalic acid, 289 
Oxidizing agent, 263 
Oxygen, 276, 283 
Oxygenation of the blood, 355 
Ozsena, 127 
Ozone, 276 

Pain in inflammation, 177 
Painful pulp, 21 
Palate bone, 443 
Palatoglossus muscle, 431 
Pancreas. 357 
Pancreatic juice, 361 
Papillae of the tongue, 344 
Papilloma of the gums, 126 
Parablast, 317 
Parasites, 172 
Parasitic bacteria, 194 

stomatitis, 116 
Parotid gland, 373, 319 
secretion, 373 



458 



INDEX. 



Passive hyperemia, 184 

Pasteurization, 174 

Patch, Smoker's, 158 

Pathogenic bacteria, 175, 181, 190 
fungi in mouth, 200 

Pathological dentition, 194 

Pathology, 171, 185 

of pulp, 22 

Pavement epithelium, 319 

Perforated hard palate, 89 

Pericardium, 324 

Pericemental abscess, 27, 120 
membrane, 346 

Pericementitis, 27, 198 

Phagedenic, 196 
Septic, 195 

Pericementum, Disease of, 202 

Perichondrium, 351 

Peridental membrane, 330, 335 

Perineurium, 317 

Periodontitis, 196 

Periosteum, 336 

Inflamed, 26 

Periostitis, 177 

Acute, 163 

of inferior maxilla, 134 
Suppurative, 144 
Syphilitic, 164 

Permanent magnet, 256 

Perspiration, 368, 383, 385 

Petrous bone, 420 

Peyer's patches, 319 

Phagedenic pericementitis, 196 

Phagocyte, 341 

Phleboliths, 191 

Phosphoric acid, 261, 288 

Phosphorus-necrosis, 402 

Physics, 249 

Physiology, 353 

Pin crown, 85 

Pinless teeth, 48 

Pits, 7 

in soldering, 72 

Plaster-of-Paris, 42, 286 
teeth, 43 

Plastic fillings, 10 

Plate clasps, Decay under, 6 

Platinized gold, 66 

Platinous gold, 66 

Platinum, 300 

in dentistry, 68 
solder, 71 

Plethora, 184 

Plumpers, 51 

Pneumogastric nerve, 360, 441 



Points, Excavator, 3 
Poisoning by atropine, 227 

carbolic acid, 225 
cocaine, 225 
strychnine, 227 
Porcelain dentures, 70 

inlays, 18 
Positive elements, 268 

metallic fillings, 314 
Potassium permanganate in den- 
tistry, 209 
Potential, 251,273 
Preparation of cavities, 2 

mouth for artificial 
denture, 41 
Pressure, Hand, 17 
Mallet, 17 
Preventive treatment of dental 

shock, 6 
Primitive dental groove, 350 
Privy, 398 
Prognosis, 188 
Prosthetic dentistry, 41 
Protection of cavities, 5 

the pulp, 21 
Proteids, 363 
Protoplasm, 334 
Provisional callus, 177 
Proximate principles, 376, 381 
Pterygoid muscles, 418 
Ptomaines, 173, 409 
Pulp, 346 

-canal, 24 

Capping of, 22, 194 

Congested, 20 

Dead, 24 

Devitalization of, 23 

Disease of, 194 

Exposed, 20, 33 

Fungoid, 25, 197 

Hyperemia of, 123 

Irritable, 197 

Irritation of, 21 

Moist gangrene of, 121 

Mummification of, 25 

Painful, 21 

Pathology of, 22 

Protection of, 21 

Putrescent, 26, 193 

Removal of, 25 

Stones, 22 

Suppuration of, 203, 205 
Pulpitis, 20, 205 
Pulpless teeth, 26 
Pulse, Normal, 367 



INDEX. 



459 



Punctured wounds, 132 
Purple of Cassius, 47 
Pus, 174, 183, 199 
Putrescent pulp, 26, 193 
Pyemia, 108 
Pyogenic bacteria, 184 
Pyorrhea alveolaris, 37, 140, 239 
Pyrozone, 202 

Qualitative analysis, 274 
Quantitative analysis, 274 
Quarantine, 404 
Quick pulse, 157 
Quinine, 21'i 

Eain water, 406 

Kanula, 101, 115, 151 

Ranvier's nodes, 340 

Red blood corpuscles, 340, 343, 370 

marrow, 321 
Reducing agent, 263 
Refining of gold, 303 
Reflex action, 385 
Regeneration of tissues, 182, 187 
Regulation of the teeth, 86 
Reinsch's test, 302 
Removable bridge, 83 
Removal of gold crown, 77 

of pulp, 25 
Repair of fractures, 186 
Replanting of teeth, 29, 105 
Reposing the features, 45 
Resorption of roots, 204 
Respiration, 368 

Artificial, 122 
Respiratory failure, 104 

organs, 373 
Retainers, 88 

Reticulum of lymphoid tissue, 323 
Retrenchment, 130 
Retzius' striae, 327 
Richmond crown, 73 
Root amputation, 28 

-canal, 24 
Roots, Resorption of, 204 
Rolando's fissure, 431 
Rose's operation, 118 
Rubber, Solvents of, 50 

Weighted, 50 
Rugae in a vulcanite plate, 92 

Saline cathartics, 244 
Saliva, 287, 353, 380, 383 
Salivary Calculus, 37, 141, 165, 189, 
201 



Salivary duct, Calculus in, 138 
fistula, 142,166 
glands, 337, 419 
Salter's lines, 328 
Sanguinary calculus, 37, 191 
Sapremia, 108 
Saprophytes, 172 
Saprophytic bacteria, 204 
Sarcolemma, 339 
Sarcoma, 172 

Myeloid, 127 
of superior maxilla, 173 
Sarcomatous epulis, 179 
Scarification, 125 
Schreger's lines, 328 
Schwann's white substance, 340 
Sciatic nerve, 447 
Secondary dentine, 7, 329, 334 
hemorrhage, 99, 168 
Secretions, 384 
Section-cutting, 321 
Sedatives, 215 
Sensible heat, 257 
Sensitive heat, 7 

anterior teeth, 6 
teeth, Treatment of, 6 
Separation of teeth, 8 
Sepsis, 172 
Septic infection, 188 

intoxication, 110 

pericementitis, 195 

wounds, 123 
Septicemia, 108, 193, 199 
Sequestrum, 118, 137 
Serous membranes, 345 
Serumal calculus, 191 
Sewage, 405 
Sewer-gas, 394 

Sharpey's perforating fibers, 325 
Shell crown, 76 
Shock, 159 

Surgical, 100 
to the teeth, 6 
Shoulder-joint, 427 
Sialagogues, 238 
Sigmoid notch, 437 
Silex in dentistry, 93 
Silver, 307 

nitrate, 38, 213, 308 
Simple cyst, 153 

molecule, 271 
Skin, 386 

Smoker's patch, 158 
Sodium, 309 

silicate, 309 



460 



INDEX. 



Soft pulse, 161 
water, 400 
Softening of cavity walls, 15 
Solder, aluminum, 60 
Soldering, 299 
Solvents of rubber, 50 
Spasmodic respiratory failure, 104 
Special pathology, 185 
Specific gravity, 249, 259 

heat, 250, 257 
Spectroscope, 254 
Spectrum analysis, 251 
Sphenoid bone, 414, 438, 439 
Sphenoidal fissure, 436 
Spinal column, 424 
Spirilla, 185 

Sponges, Sterilization of, 131 
Spongioplasm, 332 
Spongy bone, 322, 339 

gums, 120 
Spores, 171 
Sputum, 404 
Squamous bone, 420 
Stain, Green, 33 
Staphylorrhaphy, 99 
Starvation, 371 
Steno's duct, Cystic dilatation of, 

106 
Sterilization of hypodermic syr- 
inges, 180 
instruments, 99 
sponges, 131 
Sternomastoid muscle, 435 
Sternothyroid muscle, 438 
Stimulants, 213, 224 

Diffusible, 244 
Stippling, 69 
Stomach, 354, 364 
Stomatitis, 111, 116 

Gangrenous, 186 
Mercurial, 134, 200 
Stratified epithelium, 325 
Stratum granulosum, 350 

Malpighii,327 
Strychnine poisoning, 227 
Styloglossus muscle, 447 
Styptics, 217, 237 
Subclavian vein, 423 
Sublingual gland, 419 
nerve, 363 
Submaxillary ganglion, 423 
gland, 419 
secretion, 373 
triangle, 440 
Sulphur, 285 



Sulphuric acid in dentistry, 38, 

207,222,261,286 
Sulphurous acid, 261 
Superficial dental caries, 1 
Superior carotid triangle, 447 

longitudinal sinus, 423 
maxilla, 427, 439 

Fracture of, 128 
Tumors of, 134, 

183 
Sarcoma of, 173 
thyroid artery, 428 
vena cava, 430 
Suppuration, 176, 183, 200 

of maxillary sinus, 

106 
of the pulp, 203, 205 
Suppurative cellulitis, 100 

inflammation,155, 177 
periostitis, 144 
Supraorbital artery, 441 
Surgical shock, 100 
Surgery, Oral, 95 
Sutures, 117 
Suture -materials, 101 
Swaging, 59 
Sweating, 66 

Swelling in inflammation, 168 
Sylvester's method, 148 
Symbols, 271 
Sympathetic nervous system, 369, 

380, 463 
Syncope, 99, 159 
Synergist, 221 
Synovitis, 97 
Synthesis, 265. 269 
Syphilis of the mouth, 130, 174 
Syphilitic interstitial gingivitis, 
122 
periostitis, 164 
ulcers, 145 

ulcer of the tongue, 98 
Syphilitics, Operations on, 108 
System, Farrar's, 86 

Tartaric acid, 290 
Teeth, Abrasion of, 7, 196 

Artificial, 44 

Bleaching, 26 

Calcification of, 340 

Cleansing of, 39 

Color of, 26 

Counter- sunk pin, 48 

Deciduous, 205 

Deposits on, 36 



Ja'08 



INDEX. 



461 



Teeth, Devitalization of, 196 

Diatoric, 48 

English tube, 64 

Erosion of, 7, 204 

Eruption of, 202, 379, 380 

Examination of, 38 

Extraction of, 30 

Formation of, 336 

Hutchinson's, 197 

Implantation of, 105 

Irregularity of, 35, 166 

Normal occlusion of, 54 

Plaster, 43 

Pinless, 48 

Pulpless, 26 

Regulation of, 86 

Replanting of, 29, 105 

Sensitive, 7 

Separation of, 8 

Shock to the, 6 

Temporary, 32 

Transplantation of, 105 

Unerupted, 36 

Wedging of, 8 
Temperament and teeth, 45 
Tempering, 296 

Temporal artery, Ligation of, 97 
bone, 420 
fossa, 438 
teeth, 32 

Abscess of, 196 
Temporo-maxillary articulation, 
110 

Wound 
of,141 
Tenacity, 251 
Tendons, 425 
Tensor palati, 435 
Test for antimony, 302 
for gold, 302 
Thermal, 19, 196 
Tetanus, 117, 139 
Therapeutics, 207, 223 
Thermal test, 19, 196 
Thoracic duct, 447 
Thready pulse, 155 
Thrombosis, 175 
Thrust, 116, 243 
Thyroid gland, 442 
Tic doloreux, 150 
Tin, 297 
" Tin cry," 306 
Tin fillings, 11 
Tincture of iodin, 214 
Tinctures, 233 



Tissue, 341 
Tobacco, 405 
Tomes' soft fibers, 343 
Tongue, Carcinoma of, 159 

Cysts of , 101 

Gumma of, 159 

Hemorrhage from, 136 

Muscles of, 434 

Papillae of, 344 

Syphilitic ulcer of, 98 

Traumatic ulcer of, 98, 167 

Tumors of, 172 

Wounds of, 125 
Tonics, 224 
Tonsils, 416 

Toothache, 147,211,248 
Tooth - extraction, Hemorrhage 

after, 112 
Tooth-germ, 335 
Topical remedies, 231 
Torsion, 118 
Toxalbumins, 184 
Toxins, 173, 409 
Trachea, 414 

Transplantation of teeth, 105 
Traumatic dislocation, 121, 138 

ulcer of tongue, 98, 167 
Traumatism, 117 
Treatment of sensitive teeth, 6 
Triad, 264 

Trichloracetic acid, 242 
Trifacial neuralgia, 108, 164 
Trismus, 116, 146 
Tumors, 103, 175, 181, 189 

of the antrum, 126 

Benign, 178 

of buccal cavity, 179 
parietes, 173 

Epulic, 115 

Fatty, 131 

of the gums, 171 

maxillary sinus, 106 
superior maxilla, 134, 

183 
the tongue, 172 
Typhoid fever, 407 
Tyrotoxicon, 409 

Ulcer, 133, 160 

Carcinomatous, 190 

Syphilitic, 145 

of the tongue,98 

of tongue, 167 

Traumatic, of tongue, 98 
Ulcerative stomatitis, 116 



462 



INDEX, 



Underwear, 399 
Unerupted teeth, 36 
Ununited fracture 
maxilla, 136 



of inferior 



Vaccination, 393 
Vaccuum chamber, 46 
Valency, 270 
Valves of the heart, 370 
Vasoconstrictor nerves, 363 
Vasodilator nerves, 363 
Vegetable life, 273 
Veins, 372, 443 
Velum, Artificial, 89 
Ventilation, 395 
Victoria, 56 
Vidian nerve, 431 
Virulent germ, 181 
Vitriol, Blue, 285 
Volatile oils, 233 
Volatility, 250 
Voluntary muscles, 363 
Vulcanite, 50 

base, 51 

Waste, 355 
Water, 406 

of crystallization, 249 
Wedging of teeth, 8 



Weighted rubber, 50 

Welding, 299 

Wells, 412 

Wharton's duct, Cystic dilatation 

of, 106 
White decay, 4 

fibrous tissue, 338 
Willis's circle, 432 
Wisdom tooth, Impacted, 128 
Wood alcohol, 291 
Wounds, 96 

of arteries, 138 

Aseptic, 141, 166 

Contused, 96 

Healing of, 148, 183 

Incised, 143 

Lacerated, 96, 136 

Punctured, 132 

Septic, 123 

of temporo-maxillary 
articulation, 141 

of the tongue, 125 

Yellow marrow, 321 

Zinc, 315 

oxychloride, 9 
phosphate, 9 



K 82 6 



CONGRESS 




0D0Eb0fc>fi77Q 



